The method of treatment of benign diseases of the cervix
(57) Abstract:The invention relates to medicine, namely to gynecology, and can be used for the treatment of benign diseases of the cervix: ectopia and erosion, eroded ectropion and others. After laser vaporization impose additional vaginal suppositories containing at least 1 mg of dalargin, daily on 1 suppository for the night, within 8-12 days. The method allows to increase the effectiveness of treatment of benign diseases of the cervix. The invention relates to medicine, namely to gynecology, and can be used for the treatment of benign diseases of the cervix: ectopia and erosion, eroded ectropion and others.Currently, for the treatment of benign diseases of the cervix used a large number of different ways. This local application of chemicals: wagotilom, alcohol. The disadvantage of these methods is the low efficiency (18-80%). In addition, widespread for the treatment of this pathology has received an electrocautery and cryosurgery, electroconsult. These techniques are more effective than conservative. Their efficiency is 55% (PA destruction, long tissue swelling, scar deformity of the cervix, frequent recurrence and relatively low efficiency (disease of the cervix P.F. Rusakevich, Minsk, 2000, page 286, 260).One of the most effective methods of treatment of benign diseases of the cervix is the CO2laser vaporization. The effectiveness of this method is quite high and ranges from 60 to 95%. The advantage of this method is clearly controlled the depth of destruction, the lack of long-term swelling and scar tissue deformations. The disadvantage of this method are: increased bleeding, complications of inflammatory diseases and other diseases of cervix, vagina and vulva, edited by Professor C. N. Prilepsky, Moscow, 1999, pp. 190-197).The basis of the pathological process of the cervix are transferred inflammatory diseases of the lower and upper parts of the genital tract trauma to the cervix during childbirth or abortion, disorders of hormonal homeostasis and immune system dysfunction. In this regard, a stand-alone application only radical treatment methods not pathogenetically grounded, so we have developed a comprehensive method for the treatment of benign disease is the principal mechanism of action - dalargin.The invention is directed to solving objectives: increase the efficiency of the method. This object is achieved by using as a radical method of treatment of CO2laser vaporization and additional use of vaginal suppositories, including drug "Dalargin".Dalargin - a synthetic analogue of enkephalins. He has immunomodulatory, anti-stress, desegregation, anti-inflammatory, analgesic and cyto - and angioprotective action (Korobov, N. In. Pharmacology and toxicology, 1988, 4, pages 35-38). Clinical application of regulatory, including opioid peptides significantly limited by their inability oral administration due to their hydrolysis in the gastrointestinal tract. Today dalargin is applied parenterally, mainly in gastroenterological practice, therefore, it is urgent to develop new forms of the drug and its administration. An alternative method is also intranasal inhalation (Sandakova E. A. Dis... Prof. the honey. Sciences., 2001, Perm, pages 175-176). Works on the use of dalargin in gynecological practice in the form of local application of suppositories us were not found.what are the short-term finding the drug into the vagina, inaccurate dosing and inconvenience with the drug. Addressing these deficiencies, improving therapeutic efficacy, and providing prolonged local action of biologically active substances is achieved by creating a new pharmaceutical form of the drug "Dalargin" - suppositories with dalargin.All the components of the drug are available, produced by the domestic industry, i.e., the sentence "industrially applicable".Suppositories with dalargin are white monomorphic substance in the form of "candles", odorless. The composition of suppositories with dalargin: dalargin - not less than 1 mg, the base - cocoa butter 4 grams.The method is as follows: on 5-6 day of the menstrual cycle conduct laser destruction of pathologically modified area of the cervix CO2laser simultaneously. Laser vaporization was performed with the apparatus for laser surgical Sharplain (Israel) in continuous mode when output power of 40 W, the wavelength of 10.6 μm and a depth of destruction from 0.3 to 0.7 cm, the exposure time is not more than two minutes, depending on the degree of destruction. With the second or third day after laser destruction every night on 1 candle in t is.The efficiency of complex treatment was assessed by the dynamics of clinical symptoms (pain, abnormal discharge from the genital tract, body temperature), the results of dynamic colposcopy, bacterioscopic and bacteriological studies detachable cervical canal and the urethra, cytological analysis of smears, fingerprints with abnormal areas of the cervix.Clinical effectiveness is proven by the disappearance by the end of treatment pain syndrome and the reaction temperature, the almost complete cessation of pathological discharge from the genital tract. Purification of postoperative wounds much faster in patients who received integrated treatment method that is confirmed by statistically significant data having a large number of patients with low leukocyte and minimum number of patients with high levels of bacterial contamination (anti-inflammatory effect of the drug). O regenerating effect of the drug was tried on the time of rejection of the scab and the time for complete regeneration, which was confirmed data dynamic colposcopy. The rejection scab occurred on 5,42 day, as full epithelialization of the wound defect - skritogo run
Example 1. The patient And. 20 years appealed to the Cabinet of cervical pathology antenatal clinic with complaints scanty yellowish discharge from the genital tract within 5 months. From the anamnesis: Menstruation with 15 years of regular, moderate, painless, cycle 31 days 5-6 days. Sex life of 17 years, outside of marriage. Pregnancies were not. Contraception: condoms. Moved extragenital diseases: acute respiratory infections, influenza, pneumonia in childhood, chronic gastritis. From gynecological diseases notes nonspecific colpitis. In 2000, treated about chlamydial infection, currently received a negative test for chlamydia. Within 2 years found ectopia of the cervix, about which was held conservative therapy suppositories with indomethacin, herbal douching, and so on), without effect.Genital status: external genitals formed, in speculum cervix conical shape, the external OS is rendered bright red spot at durgiana bleeds. Bimanual vaginal examination pathology of internal organs is not detected. Advanced colposcopy: on the cervix ectopia, the transformation zone with open duct is Well with the pathological area with a scalpel biopsy - glandular cervical erosion. they without features. Smear vaginal smear: leukocytes 2-3 in eyeshot, bacillary flora, reasonable. Bacteriology separate cervical canal - abundant growth of Staph. epiderm. hamalsarany.On the 7th day of the menstrual cycle in aseptic conditions produced CO2laser vaporization with a capacity of 40 W at a wavelength of 10.6 μm in 40 seconds, simultaneously, with the depth of destruction of 0.5 cm pathologically modified area of the cervix without technical difficulties. With 2 days from radical treatment assigned suppositories with dalargin, which was administered daily for 1 candle on the night for 10 days.At the end of treatment, on day 27, performed a control advanced colposcopy, where you stated the main mucous of the cervix. Complaints the patient does not show. The treatment was well tolerated. they - smear-negative cells of the squamous epithelium without evidence of malignancy. Smear cervical discharge - leukocytes 4-6 field of view, bacillary flora, reasonable. Bacteriological examination of cervical detachable growth of pathogenic microorganisms not found.Example 2. Patient K. 27 years drew is no complaints. From the anamnesis: menstruation at the age of 13, was installed immediately, a cycle of 28 days, regular, 5 days, moderate, painful. Sex with 18 years of marriage. Contraception - the Navy for 5 years, coitus interruptus. Pregnancies 4, of these genera 2, 1 miscarriage, honey. abortion 1; Extragenital diseases: acute respiratory infections, influenza, XP. the colitis. Gynecological disorders: a polyp of the cervical channel, removed a year ago. Noteworthy history of cervical erosion, about 8 years ago produced diathermocoagulation. Relapse ectopia in 3 years. Gynecological status: external genitals correctly formed in the mirrors the neck is cylindrical, hyperemic, plot ectopia small size. Bimanual vaginal examination of gross pathology of internal organs is not detected. Colposcopy: in the cervical canal expansion mucosa in the form of a polyp, ectopia with the atypical transformation zone with acetabulum epithelium. Conclusion: recurrent cervical ectopia. Atypical transformation zone. A polyp of the cervical channel. Histological diagnosis of glandular cervical erosion. Smear cervical discharge: leukocytes 2-3-5 in the field of view, bacillary flora of usercontrola.On day 6 of the menstrual cycle produced CO2laser vaporization of pathologically modified area of the cervix at a wavelength of 10.6 µm with an output power of 40 W, at a depth of 0.7 cm, the exposure time of 47 seconds. From the 3rd day started daily administration of suppositories with dalargin on 1 thing at night, just 10 vaginal suppositories. Treatment the patient felt fine. Examined on the 29th day of starting treatment. When visiting no complaints. The condition is satisfactory. A control colposcopy: on the cervix diagnosed primary mucosa. they: cells of the squamous epithelium without evidence of malignancy. Smear vaginal smear - leukocytes 4-6 in sight, flora polymorphic, reasonable. Bacteriological examination of separate cervical canal growth pathological microflora was not found.Example 3. Patient D. 28 years appealed to the Cabinet of cervical pathology complaining nagging pain in the lower abdomen for 2 years, not associated with the menstrual cycle. From the anamnesis: menstruation with 13 years, a cycle of 28 days, regular, 4-7 days, moderate, painless. Sex life with 17 years of marriage. Contraception: IUD. Pregnancies 3, of these genera 2, medical abolit. Gynecological disorders: sanitized 6 years ago about ureamikoplazmoza currently received a negative test for urogenital infection. Gynecological status: external genitals correctly formed in the mirrors the neck is cylindrical, mucous allocation, plot ectopia small size. Colposcopy: on the cervix ectopia, atypical transformation zone with cystic dilated glands, open the ducts of glands with a border. Conclusion: Eroded ectropion. Atypical transformation zone. they without features. Histologically diagnosis: Eroded ectropion of cervix uteri. Smear separate cervical canal and urethra: leukocytes 3-5 in the field of view, flora polymorphic, abundant. Bacteriological examination of cervical content: abundant growth of Escherichia coli.On the 7th day of the menstrual cycle produced CO2laser vaporization abnormal area of the cervix at a wavelength of 10.6 microns, power 40 W, at a depth of 0.5 cm, the exposure time of 35 seconds. With 2 days started introduction vaginal suppositories with dalargin on 1 suppository for the night, for 12 days. The treatment was well tolerated. At the time of inspection, on the 29 day, the patient JCAHO epithelium without evidence of malignancy. Smear: leukocytes 4-6 in sight, flora polymorphic reasonable. Bacterial adherence separate cervical canal: sparse growth of Staph. epiderm., hemolysis.A comprehensive method of treatment has the following advantages:
1. The reduction of treatment time: full cure occurs on the 29th day, which was confirmed by a control colposcopy, in which States the main mucosa (prototype method 30-34 days).2. Comfort and physicians need of the drug. Suppositories with dalargin is well tolerated by the patients, without creating discomfort, do not cause complications and adverse reactions, have good solubility in the vaginal environment have multilateral favorable effect on the body.3. The diversity of actions. Suppositories have immunomodulatory, anti-inflammatory, analgesic and cytoprotective effect.4. Simplicity, accessibility and efficiency of obtaining suppositories does not require special equipment and high economic costs.5. The stability of the components of the drug "Dalargin in suppositories. The convenience of storage and transportation. Suppositories, divided by the piece and is so The method of treatment of benign diseases of the cervix with the help of CO2laser vaporization, characterized in that after laser vaporization impose additional vaginal suppositories containing at least 1 mg of dalargin, daily on 1 suppository for the night, within 8-12 days.
where R1is benzyl or tert-butyl; R2not equal to R1and is selected from the group of tert-butyl; benzyl; 4-methoxybenzyl; 4-nitrobenzyl; diphenylmethyl; 2,2,2-trichloroethyl; 2,2,2-trichloro-1,1-dimethylethyl; allyl; 9-fluorenylmethyl; carboxamidine; substituted 2-sulfonylated type AND-SO2-CH2-CH2- where a is substituted or unsubstituted phenyl or benzyl; R3is a hydrogen atom or a urethane protective group of the B1O-CO-, where1not equal to R1and can take values tert-butyl, benzyl, 4-methoxybenzyl, 9-fluorenylmethyl, 2-(4-nitrophenyloctyl)ethyl; or is a peptidyl containing from one to three amino acid residues; and the peptides, where R3- peptidyl structure E-Z-Y-X-, in which E is a hydrogen atom or a urethane protective group IN2O-CO-, where2not equal to R1and can take values tert-butyl; benzyl; 4-methoxybenzyl; 9-fluorenylmethyl; 2-(4-nitrophen is IN3O-CO-, in which3= R1attached to the omega-amino group; Z can take values Phe or D-Phe
FIELD: medicine, otorhinolaryngological surgery.
SUBSTANCE: one should apply thin layer of "Solcoseryl" gel onto osseous facial walls of frontal and maxillary sinuses at the border with trepanation opening after removing pathological content out of them and before applying a transplant out of flat bone of human fetal cranial arch that exceeds the diameter of trepanation opening by 3-4 mm. Then, one should additionally fix the transplant by affecting with distal edge part of a light guide of semi-conductor laser "ATKUS-15" with contact-type technique at output power of laser radiation being 8 W at constant mode. The method enables to increase fixation density of allobrefobone to osseous walls of sinus along its whole diameter.
EFFECT: higher efficiency of fixation.