The method of complex treatment endourethral warts, localized in the posterior third of the hanging part of the urethra
(57) Abstract:The invention relates to medicine and can be used to treat endourethral warts, localized in the posterior third of the hanging part of the urethra. Dissolved in 6 ml of sterile isotonic IFN is administered in the form of instillation into the urethra at the dosage of 1 million to ME. Then the projection area of the penis affect magnetic field using the apparatus "MILTA" within 10 min, a frequency of 1000 Hz, a day, a course of 15 treatments. The proposed method can improve the effectiveness of the treatment, characterized by the absence of local recurrence and complications. The invention relates to medicine, namely to venereology and urology.The manifestation of human papillomavirus infection in the urethra in men (endourethral genital warts) is one of the complex medical and social problems because of the difficulty of diagnosis and treatment, as well as the possibility of reproductive disorders. Despite the fact that most often genital warts are located on the external genitalia, in recent years there has been a high percentage (>20%) endourethral localization. The main methods of treatment (cffect, cause suffering to the patients, and many of them difficult in technical execution and cause local complications.Similar to the inventive method, the authors propose a combined method of treatment endourethral warts: preparations of human leukocyte interferon (CLI), lacenterra and removing endourethral condylomas high-energy (surgical) laser apparatus Scalpel-1" (Dubno centuries, Kuznetsov, B. N., Belyaev D. L. Comparative effectiveness of various methods of treatment of human papillomavirus infection. Collection of scientific works: current problems in dermatology and venereology, 2000), S. 5-46). CLI was administered topically to the lesions on 100 thousand IU/ml, daily, in the course of 3 injections. Lacapere used in the form of intramuscular injection of 10 thousand BD every other day, at the rate of 20 injections. A week after local injection of CLI in the lesion was performed resection of the endourethral condylomas high-energy laser (continuous output power greater than 4 W) on the device "Scalpel-1". The effectiveness of lasertechnologie with local and systemic application of drugs interferon 60-92,5%, but is accompanied by a prolonged nezazelene RAS (up to 3-4 weeks), and the possible accession of tipam is a method of combined treatment endourethral warts using endourethral use of low (therapeutic) red laser radiation and intramuscular injection of human leukocyte interferon (Dubno centuries, Redko R. C., FSH A. A. Method of complex treatment of endourethral warts. Patent 2170114, July 10, 2000). Treatment was started with intramuscular injection of human leukocyte interferon 500 thousand IU/ml after day, in the course of 15 injections. On the background of immune conducted endourethral low-intensity (therapeutic) red laser effect through a special nozzle 10 through the emitter To 30 (with output power of 30 mW) apparatus AZOR-2K daily for 10 days. This method is effective in the localization of warts near the external orifice of the urethra. However, localization of warts in the rear third of the hanging part of the anterior urethra due to insufficient local concentrations of interferon (due to system usage) rate is significantly reduced and increases the number of relapses endourethral warts. In addition, invasive (endourethral) application of the red laser radiation inconvenience to the patient, requires a special nozzle and conditions for sterilization.The authors propose their own method of complex treatment of endourethral warts, lorate magnitolazeroterapii MILTA" solution reaferona (genetically engineered interferon ) in a dose of 1 million ME on the course, 15 procedures.The procedure is carried out as follows: the head of the penis freed from the flesh and, holding the fingers of the left hand, right hand gently and slowly introducing endourethral solution reaferona in the form of instillation in the dosage of 1 million ME, dissolved in 6 ml of sterile isotonic solution with a syringe for injection (10 ml) and urethral catheter. Next projection in the region of the penis, vozdeystvuut laser magnetic field using the apparatus "MILTA" (decision of the Committee on new technology of the Ministry of health and medical industry of the Russian Federation, Protocol 3 from 15.03.93 year ). Carry out the procedure within 10 minutes with a frequency of 1000 Hz, a day later, in the course of 15 treatments. After remaining in the urethra solution release.Under our supervision was 74 patients aged 19 to 46 years, with disease duration from 0.5 to 8 years, showing the complaints to pains in the urethra, minor urethral discharge and split urine stream.Ureteroscopy on flexible fiberscope "URF-P2" company "OLYMPUS" (Japan) allowed to identify all patients endourethral HPV hanging part of the urethra.Mikrobiologisches the research has established the immunosuppression, affecting interferonogenez, inhibition of T-cell immunity and early activation of lymphocytes.All patients were treated with endourethral low-intensity laser radiation and intramuscular injection of human interferon (CLI).After the course of treatment repeated ureteroscopy established cure endourethral warts in patients whose warts were located in the anterior third of the hanging part of the urethra (48 patients), healing does not come from those who have warts were located in the rear third of the hanging part of the urethra (26 patients).These patients were treated with magnetoterapia solution reaferona, in the course of 15 treatments.After treatment ureteroscopy established cure in 92.3% of patients.Remote observations in the period from 1 year to 2.5 years have confirmed a strong recovery and no recurrence endourethral warts.Thus, the method is highly effective in the treatment of endourethral warts with deep localization leads to a high rate of recovery, characterized by the absence of local recurrence and complications.Pri, split urine stream. Considers himself ill for 2.5 years, when for the first time under the foreskin noticed a flesh-colored nodule the size of a small pea. After 1 month in connection with the increase in the number and size of entities addressed to the dermatologist. Education were subjected to electrocoagulation, but complaints of the patient is preserved. External genitals are developed correctly. The urethral sponge is slightly hypermonogenic. On the glans penis rash no. When examination of scrapings from the urethra: leukocytes 3-6 p/SP., pl. epithelium - unit in R/La. Methods DFA and PCR pathogens infections are not detected.Urethrocystoscopy on the fiberscope company "Olympus" has shown that bladder - vascular drawing is not changed, trabeculoplasty expressed, the mouth of the ureter slit, not deformed, education and defects on the mucous membrane absent; posterior urethra - the presence of transient infiltration, seed tubercle slightly increased; the front is the Central figure of the deformed and gaping, vascular pattern is expressed, slimy pink-white, Littre gland and crypts of Morgagni is not inflamed. In the rear third of the hanging part of the anterior urethra detected endourethral genital warts, thin and short stalk.Diagnosis: MBC: endourethral genital warts rear third of the hanging part of the anterior urethra. Chronic urethritis (colliculi, transient infiltration).The treatment was performed using endourethral instillation solution reaferona in the dosage of 1 million ME, dissolved in 6 ml of sterile isotonic. Then the projection area of the penis was affected by the magnetic field and infrared laser radiation using the apparatus "MILTA". The procedure was carried out for 10 minutes with a frequency of 1000 Hz, a day later, in the course of 15 treatments.After 8 sessions disappeared burning in the urethra. The termination of the split urine stream achieved by 12 procedure.When the control urethrocystoscopy normalization form seed tubercle, the Central figure is saved, appeared radialnet vascular pattern in the urethra. Warts and other lesions in the urethra not. In the follow-up period (2 years) recurrence of the disease was not. The method of complex treatment endourethral warts, localized in the posterior third of the hanging part of the urethra, including endourethral the use of interferon, wherein dissolved in 6 ml sterile is Onno effect magnetic field using the apparatus "MILTA", within 10 min, a frequency of 1000 Hz, a day, a course of 15 treatments.
SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule of 3-4 mm in size in choroid hemangioma projection to sclera 3-4 mm far from limb. Tunnel is built between sclera and Tenon's capsule to extrasclerally introduce flexible polymer magnetolaser implant through the tunnel to the place, the choroid hemangioma is localized, after performing transscleral diaphanoscopic adjustment of choroid hemangioma localization and size, under visual control using guidance beam. The implant has permanent ring-shaped magnet in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 2-3 mTesla units intensity. It is arranged with its north pole turned towards the choroid hemangioma so that extrascleral implant laser radiator disposition. The other end of the implant is sutured to sclera 5-6 mm far from the limb with two interrupted sutures through prefabricated openings. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. 0.1-1% khlorin solution is injected in intravenous bolus dose of 0.8-1.1 mg/kg as photosensitizer and visual control of choroid hemangioma cells fluorescence and fluorescent diagnosis methods are applied. After saturating choroid hemangioma with the photosensitizer to maximum level, transscleral choroid hemangioma laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm with total radiation dose being equal to 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the intraocular neoplasm, repeated laser irradiation of the choroid hemangioma is carried out with radiation dose of 30-60 J/cm2.
EFFECT: enhanced effectiveness of treatment.