The use of triplostegia
The invention relates to medicine, urology, and can be used for the treatment of autoimmune infertility. Use cryoplasmasorbtion. This invention contributes to the improvement of quantitative and qualitative indicators of spermatogenesis, including the increase in the concentration of spermatozoa and their mobile forms that, in turn, improves the effectiveness of treatment of autoimmune infertility in men. table 1.
The invention relates to medicine, in particular to urology, and can be used in the treatment of autoimmune infertility in men.
There is a method of treatment of autoimmune infertility in men, including intravascular ultraviolet blood irradiation (WOFAK) (Korenkov, D., Maryanov C. E. and other Efficiency intravascular ultraviolet irradiation of blood in autoimmune infertility in men // Vestnik of Saint Petersburg state medical Academy. I. I. Mechnikov. - №1-2 (4). - 2003. - S. 115-118). Use WOFAK normalizes the function of hepatolenticular barrier, improves microcirculation, promotes the “reset” antisperm antibodies (AST) from diseased genitals (testicles) in the vessel.
There is a method of treatment of autoimmune infertility in men, including the introduction of prednisolone at a dose of 40 mg/day courses of 3-5 days (C. A. Bogdonov etc. // Andrology and genital surgery, 2000. No. 1. - S. 50). Introduction prednisolone short courses in specified doses suppress the production of anti-sperm antibodies, however, the effectiveness of this method of treatment is low.
The disadvantage of these methods is that the circulation of antisperm antibodies and immune complexes in the blood of the patient is continued for a long period of time, which affects the quality of sperm.
In recent years a significant role in the damage of membranes of sperm, until necrosphere, given the active forms of oxygen resulting from ischemia of the genitals with their injury or illness and trigger activation reactions of free radical oxidation of proteins and lipids in the membranes of germ cells. However, these methods do not affect this part of the pathogenesis of autoimmune infertility in men.
The objective of the invention is to improve quantitative (volume and number of spermatozoa) and quality (sperm motility, morphology, resistance, fertilizing ability) the problem is solved in that in the known method of treatment of autoimmune infertility in men, according to the invention, optionally undergo triplostegia.
Conducted by the authors showed that cryopreserve leads to reducing the concentration of AST, immunoglobulins, reactive oxygen species and free radical oxidation products of proteins, lipids and ascorbic acid (disulfide group (SS-gr), malondialdehyde (MDA), oxidized form of ascorbic acid (OFAC)) in the blood and ejaculate.
Blockade of the formation of AST, due to immunomodulatory therapy, and active excretion of the vascular bed and diseased genitals excess of antisperm antibodies and products of free radical oxidation due course of triplostegia, improve the quantity and quality of spermatogenesis, thereby increasing the effectiveness of treatment of autoimmune infertility in men.
Cryoplasmasorbtion carried out by well-known methods (A. A. Sokolov, A. L. Kostyuchenko, K. Y. Gurevich, M. C. bila Tserkva - in the book. Efferent therapy in complex treatment of diseases of accumulation, SPb. - 1998 - N-35-37) as follows.
The beginning of the operation is the usual plasma is SMI immediately frozen for 16-18 hours at a temperature of minus 20 degrees With adding heparin in the amount of 10 thousand ED. Calculation exposuremanager volume of the plasma produced by the formula: - blood volume (CBV) is 7% of the body weight of the patient, i.e. the patient weight of 70 kg 4900 ml Given that the hematocrit in the norm is equal to 45%, then the total plasma volume of the BCC will be equal to: 4900 ml - 100%, and 55% 2695 ml. Thus, the extracted plasma in 40% of the volume will be equal 1078 ml Substitution of the collected plasma produce simultaneous intravenous crystalloid and colloid solutions in the ratio 2:1. Note that if the remote plasma volume is compensated only crystalloid solutions, infusion volume should be increased by 3-4 times compared with the volume eksponirovannoi plasma. Before the next operation previously extracted plasma is thawed at a temperature of 4 degrees C, and the clot heparin cryoprecipitate precipitated by centrifugation at a speed of 1000 rpm for 5 minutes. Then the supernatant plasma perfusion through non-selective carbon sorbent (HC - 5, SKN - 2 m, or other) at a ratio of sorbent-sorbate - 1:10 or 1:20 and return intravenous patient. Plasma obtained during each subsequent plasmapheresis, is treated similarly. Each time the volume for the - -4 1-2 days.
The method is illustrated by the following clinical examples.
1. Patient R., 26 years old, came for infertility in marriage. History of trauma to the scrotum with damage to the right testicle. In the semen: sperm count 38 million in 1 ml motile sperm - 32%, degenerative form of 50%. In the blood: ASAT - 2650 IU/l, SS-gr - 5,31 mmol/l, MDA -5,50 mmol/l, OFAC - 39,1 mmol/l In the ejaculate: ASAT - 305 IU/l (N - 75 IU/l), SS-gr - 6,01 mmol/l, MDA - 5,32 mmol/l, OFAC - 50,1 mmol/L. Diagnosis: autoimmune infertility, asthenozoospermia. After treatment with prednisolone was administered a course of triplostegia in the amount of 3 treatments a day. In the blood the number of AST decreased to 171 IU/l, SS-gr - 3.95 mmol/l, MDA - 3,41 mmol/l, OFAC - 36,9 mmol/l In the ejaculate quantity AST decreased to 80 IU/l, SS-gr - 4,11 mmol/l, MDA - 3.1 mmol/l, OFAC respondents (40.1 mmol/l Control tests of semen after treatment - the number of sperm - 69 million in 1 ml of mobile forms - 68%, degenerative form - 36%.
2. The patient M, 34, asked about the lack of children in the marriage for 5 years. Patient history underwent surgery for a varicocele. When surveyed in the semen sperm count 30 million in 1 ml of mobile is To - 39,1 mmol/l In the ejaculate: ASAT - 298 IU/l, SS-gr - 6,03 mmol/l, MDA - 5.40 mmol/l, OFAC and 50.4 mmol/L. Diagnosis: autoimmune male infertility, oligozoospermia. After treatment with prednisolone was administered a course of triplostegia 4 treatments a day. After the course number AST in the serum decreased to 120 IU/l, SS-gr - 3,91 mmol/l, MDA - 3,39 mmol/l, OFAC at 36.1 mmol/l In the ejaculate quantity AST decreased to 80 IU/l, SS-gr - 3,98 mmol/l, MDA - 2,95 mmol/l, OFAC - of 40.3 mmol/l At follow-up semen after treatment: the number of sperm to 61 million in 1 ml of mobile forms to 59%, degenerative forms - up to 28%.
3. Patient Y., 30 years old, came for infertility in married for 4 years. History of surgery for injuries of the scrotum. When surveyed in the semen sperm count 25 million in 1 ml of mobile forms 30%, degenerative forms 42%. In the blood the number of AST was 125 IU/l, SS-gr - 5.41 mmol/l, MDA - 5,62 mmol/l, OFAC respondents (40.1 mmol/l In the ejaculate AST - 850 IU/l, SS-gr - 5,97 mmol/l, MDA - of 5.29 mmol/l, OFAC of 51.0 mmol/L. Diagnosis: autoimmune infertility.
After the course (5 sessions) WOFAK the amount of AST in the ejaculate has decreased to 102 IU/l and serum increased esto AST decreased to 68 IU/l, SS-gr - 3.9 mmol/l, MDA - 3,12 mmol/l, OFAC - 36,9 mmol/l In the ejaculate, the number of AST was 98 IU/l, SS-gr - 4.14 mmol/l, MDA - 3,12 mmol/l, OFAC - 42.1 mmol/l
Control tests of semen after treatment, the number of 38 million sperm per ml with mobile forms 45%, degenerative forms 30%.
According to the claimed method were treated 32 patients with autoimmune infertility in age from 22 to 37 years of age receiving inpatient treatment. All patients were somatically healthy. The average duration of disease was 4,0±0,5 years.
The main clinical causes of the infertility was varicocele, testicular trauma and cysts in the field of appendages. All the patients before applying triplostegia a long time received conventional therapy: corticosteroids, immunosuppressants, and proteolytic enzymes.
Testimony to the appointment of triplostegia was the lack of effectiveness of traditional drug therapy and some efferent methods hemocorrection (plasmapheresis, hemosorption with plasmapheresis in the same circuit), high content of anti-spermatozoa antibodies in blood and semen and the lack of positive dynamics of semen.
Bioplasma RAM: prednisolone 30 mg 3 times a day per os - 5-6 days;
- trental 300 mg in 400 ml reopoligliukina 2 times a day drip, slowly, intravenously 5-6 days;
- antioxidants: unithiol 5% solution of 1.0 ml/10 kg body weight in combination with ascorbic acid 5% solution of 0.3 ml/10 kg body weight intravenously every four hours for 5-6 days and-tocopherol 40 mg/kg body weight intramuscularly 5-6 days;
- intravascular ultraviolet blood irradiation (WOFAK) daily or every other day - 5-6 sessions per course of treatment.
Estimated indicators of free radical oxidation, semen, content AST in the blood and ejaculate.
Changes in the indices of free radical oxidation in patients source was characterized by a reliable increase in the content of oxidized forms of proteins, lipids and ascorbic acid with a sharp decrease in antioxidant protection as blood and semen. The most pronounced changes in the indices of free radical oxidation was observed in the ejaculate: the content of disulfide groups and oxidized forms of ascorbic acid was higher than in blood, 13 and 28%, respectively, and the level of superoxide dismutase - below 23% (see table).
Changes in the indicators of treatment outcome are presented in the table.
3 months after treatment tended to decrease both blood and semen antioxidantes activity, increased levels of oxidized forms of free radical oxidation, the increase in the level of AST. These changes are an indication for re-treatment using triplostegia.
Using the proposed method can improve the quantity and quality of sperm production, increase the efficiency of treatment of autoimmune infertility in men.
The use of triplostegia for the treatment of autoimmune infertility in men.
FIELD: medicine, oncology.
SUBSTANCE: the present innovation deals with treating patients with uterine cervix cancer with relapses in parametral fiber and in case of no possibility for radical operative interference and effect of previous radiation therapy. During the 1st d of therapy one should intravenously inject 30 mg platidiam incubated for 1 h at 37 C with 150 ml autoblood, during the next 3 d comes external irradiation per 2.6 G-r. During the 5th d of therapy one should introduce the following composition into presacral space: 60 ml 0.5%-novocaine solution, 1 ml hydrocortisone suspension, 2 ml 50%-analgin solution, 1 ml 0.01%-vitamin B12 solution, 1.6 g gentamycine, 800 mg cyclophosphan, 10 mg metothrexate. These curative impacts should be repeated at mentioned sequence four times. The method enables to decrease radiation loading and toxic manifestations of anti-tumor therapy at achieving increased percent of tumor regression.
EFFECT: higher efficiency of therapy.