Method for treating chronic salpingo-oophoritis

FIELD: medicine, gynecology.

SUBSTANCE: one should carry out galvanization during 15 min due to applying electrodes along abdominal-sacral technique. Just before galvanization one should introduce 15 ml 2%-chitosan ascorbate gel containing metronidasol at the dosage of 2 mg/ml gel, intravaginally at 36-38° C. Procedures should be carried out once daily, therapy course lasts for about 7-8 d. The innovation suggested provides total curative effect of antibacterial remedies and galvanization at decreased dosage of metronidasol and, thus, enables to obtain stable remission of salpingo-oophoritis.

EFFECT: higher efficiency of therapy.

1 ex, 1 tbl

 

The invention relates to medicine, namely to gynecology, and can be used for the treatment of chronic oophoritis.

The urgency of the problem is determined by a high frequency, the tendency to generalization and chronic inflammation of the female genital organs, long-term, relapsing course; the development of major pathophysiological and pathomorphological changes in the affected tissues. The formation of adhesions in the pelvis significantly affects the quality of life of women is the cause of infertility, miscarriage and ectopic pregnancy, impaired sexual, menstrual function. Adhesive process leading role in the pathogenesis of chronic pelvic pain, which often lead to the development of neurotic States. Are involved in pathological process of the immune, nervous, endocrine, reproductive, digestive, and urinary systems of the body. Reduced work capacity of women, often there are conflicts in the family[1, 2, 3].

There are various ways to treat chronic oophoritis, consisting of antibacterial, anti-inflammatory, pain medications, physical therapy and its health impacts, health resort treatment. To reduce medical tonneu burden on a woman's body and improve the effectiveness of treatment is widely used physical methods of influence: carrying out electrophoresis of the uterus mud extract "Isobel" with the simultaneous effect of through the vagina alternating magnetic field; electrophoresis of the uterus 1% silt sulfide mud; low-frequency magnetotherapy and intravascular laser irradiation of blood; hydrogen sulfide therapy in the form of vaginal lavage and General baths by influence on biologically active points of the electromagnetic radiation; EHF-therapy on paired reflex points of the uterus and ovaries with the connection through the day bromine balneotherapy in the form of vaginal irrigation and public baths; hyperbaric oxygen therapy; laser therapy and vaginal hypothermia[4, 5, 6, 7, 8, 9].

However, the traditionally used methods of treatment of chronic oophoritis not effective enough, because it is not always possible to achieve complete rehabilitation of patients to prevent relapse, to achieve stable remission of the disease. Mud components may develop allergic reactions, most of the methods are difficult to implement and not available for General use with socio-economic aspects. All this necessitates the search for new effective treatments to achieve remission to prevent relapse, reduce the frequency of their occurrence, to prevent the development and to reduce adhesions in the pelvis, which significantly affects the quality of life of women.

Most b is izkuyu to the claimed is a method of treatment, consisting in carrying out electrophoresis with 3% solution of potassium iodide on abdomino-sacral technique (the cathode in the region of the pubis, the anode on the sacral area), current up to 10 mA, which is picked individually, to increase light tingling sensations, the exposure time is 20 min, the number of procedures 10-12 [11]. The disadvantages of this method are

- the duration of the session;

- lack of effective treatment;

- high frequency of relapses;

- minor ability to reduce adhesions in the pelvis.

The problem solved by the invention, the efficiency of treatment to achieve remission, reduction of adhesions in the pelvis, relief of chronic pain, improving the quality of life of women, reduction of terms of treatment and rehabilitation activities.

The task of reach due to the fact that, as a medicinal substance use 2% gel of chitosan ascorbate, containing metronidazole at a dose of 2 mg/ml, in a volume of 15 ml, the temperature of 36-38°, 1 times a day just prior to electroplating, the rate of 7-8 days, the exposure time is 15 minutes.

The method is as follows. In the treatment room in the Trendelenburg position on the gynecological chair before galvanization carry out reorganization of the Nar is the author of the genital organs with an antiseptic solution, introduced into the vagina mirror Cuzco, with a cotton swab on the clamp handle mucous membrane of the vagina aqueous solution furatsilina 1:5000, moisten a dry cotton swab on the clamp 2% gel of chitosan ascorbate with metronidazole temperature 36-38°With 15 ml of 1 times in day. Galvanization use the apparatus ("Thread-1"), the electrodes are imposed on conventional abdomino-sacral technique (the cathode in the region of the pubis, the anode on the sacral area). When this current picked individually from 5-10 mA, which increased to a light tingling sensations. The procedure is about 15 min for 7-8 days.

As the basis for pharmaceutical compositions using the biopolymer polysaccharide nature 2% finely dispersed water-insoluble gel of chitosan ascorbate (medical product of the deacetylation of chitin shell crab, deacetylation 75-99%, a molecular weight of between 100 to 700 kDa, pH 5.5-7.4).

The drug is characterized by a high biocompatibility, low toxicity, Biodegradability, antimicrobial, anti-toxic and mucoadhesive properties, odorless, slightly opalescent, can absorb antigenic material by electrostatic, chelate or affine mechanism. The mechanism of action of chitosan polymer based on the fact that provided a natural barrier between Vespa is sustained fashion hearth and chitosan is formed mucoadhesive membrane, which in the acidic environment (vagina) due to the positive charge of the biopolymer provides interaction with anionic components of epithelial cells. The result is an asymmetric contraction of the cytoskeleton of cells diverge apical cell fragments and, as a consequence, open tight intercellular contacts, increasing parallelity transport, there is a phenomenon of the perfusion liquid and the cell parts in the direction of a charged polymer. Penetrating into the tissue, chitosan absorbs the products of inflammation (BAS), inhibiting phagocytosis and cell migration, allows you to create favorable conditions for attracting peritoneal macrophages, which interrupts the circuit of the pathological process, as exhibit antagonistic properties against fibroblasts and their products, preventing the organization and formation of extensive adhesions. Due to the adhesive properties of chitosan occurs adhesion of fibroblasts and inhibited the overproduction of fibrous tissue.

The main purpose of application is the treatment of chronic oophoritis due to the excretion of antigenic material that causes inflammation, normalization of vaginal microflora to prevent the upward path of infection, prevention and reduction of adhesions in the pelvis due to the summing of the gel through the vagina, ensuring their close anatomic proximity to the adhesive process, relief of chronic pain syndrome.

Were examined and treated 10 patients aged 20-40 years, the mean age was 29.7 years. All patients on the basis of complaints, anamnesis of the disease, the clinical picture, vaginal status, laboratory and instrumental and additional methods of examination diagnosed chronic oophoritis with a strong adhesive process. In the subacute stage and remission of chronic oophoritis was appointed our proposed method of treatment: galvanization with a preliminary introduction vaginally 2% gel of chitosan ascorbate, containing metronidazole at a dose of 2 mg/ml on the pad.

Prior to treatment the patient showed the following complaints: constant pain in the pelvis, which is manifested pulling pains in the lower abdomen, radiating to the lower back, sacrum; menstrual dysfunction: painful, heavy menstruation, menstrual disorder; dysuric phenomena; constipation; increased secretions from the genital tract. Anamnestically: number of exacerbations during the period 2002-2004 was beside each patient on average 4 times. A vaginal examination all women in varying degrees, determined by the tenderness in the lower abdomen, tenderness to palpation of the appendages, limiting the mobility of the appendages, Proc. of the bullying; appropriate their palpation due to the clear adhesions, tyazhistye structure of the appendages, tenderness on cervical traction, limiting the mobility of the uterus, the position of the uterus in the pelvis retroflexio, Beli. All women have performed the test for the study of the composition of the microflora, which found increased numbers of leukocytes, epithelial cells, the presence of gram-positive cocci. Bacteriological examination detected the growth of normal microflora in 7 women, Gardnerella vaginalis 1 women, Staphilococcus aureus in 2 women, focused on the clinical analysis of blood revealed a mild leukocytosis, a slight increase of erythrocyte sedimentation rate (ESR). One of the additional criteria of treatment efficacy was the measure of the deformability of erythrocytes (PDE), allowing to assess the condition of the membrane structures of cells, the severity of endogenous intoxication in infectious-inflammatory processes. The rate of erythrocyte deformability was assessed by the conventional method and Dormandy modification Wiegenstein [10]. All women PDE was above normal values. When ULTRASOUND was determined signs of oophoritis (increase in size of the ovaries, the presence of liquid inclusions in the stroma of the ovary, indirect signs of adhesions in the pelvis).

The proposed method was treated with 10 women, formed the first group, which during the 7-8 day is after the preliminary vagina sanitation water furatsilina 1:5000 before galvanization was administered vaginally 2% gel of chitosan ascorbate with metronidazole in a dose of 2 mg/ml on the tampon in the amount of 15 ml of 1 every day, the duration is 15 minutes.

The second group consisted of 10 women who are in acute and remission electrophoresis was carried out with 3% solution of potassium iodide with the electrodes on abdomino-sacral technique, current up to 10 mA, exposure time 20 min, the number of procedures 10-12.

The results of the study were assessed on the following criteria: complaints of the patient, gynecological examination, bacteriological examination of the vaginal flora (smear microscopy and culture diagnosis), clinical blood analysis and PDE.

Table 1

The characteristic clinical signs of chronic oophoritis in the dynamics of treatment.
The signs of the diseaseGalvanization with gel ascorbate-chitosan-metronidazoleElectrophoresis with 3% solution of potassium iodide
Days of treatment3571035710
Pain+---++++++-
Tenderness to palpation in the lower abdomen+ +--+++++++-
The tenderness of the epididymis++++--++++++-
Limited mobility appendages++++-+++++++-
Tyazhistye structure appendages++++--+++++++-
Tenderness on cervical traction+++--+++++-
Limiting the mobility of the uterus++++++-+-++++++++
The position of the uterus in the pelvis (retroflexio)++++++-+++++++
Having whiter+++--++++ +-
PDE12%7%5%4%12%10%9-8%6%
The increase in size of the ovaries by ultrasound+++--+++++-
Note: (+++) the attribute is significant, (++) the attribute is satisfactory (+) sign expressed indefinitely (-) sign is missing.

During the treatment in the first group of patients with complaints of lower abdominal pain disappeared by the end of the third day, for 5 days in 90% of women, pain in the lower abdomen and lumbosacral region was absent. By the end of 5 days significantly decreased the number of vaginal discharge 70% of women, on the seventh day Beli patients were absent. Bimanual examination: 5 day remained insignificant tenderness to palpation of the adnexa in 20% of women, on day 7, the sensitivity of the appendages to palpation were absent; limiting the mobility of the appendages to the end of 7 days was preserved in 10% of women; limiting the mobility of the uterus for 5 days remained at 30%, and on day 7 in 10% of women; the position of the uterus in the pelvis anteflexio on day 7 in 80% of women. The rate of erythrocyte deformability cured to whom I was 14%, and on the 7th day of treatment in all women was within the normal range (0-6%), which indicates a decrease in the inflammatory process and the effectiveness of treatment. 2 women bacteriological examination of discharge from the vagina before treatment was found Staphilococcus aureus, 1 women Gardnerella vaginalis, after treatment in the study of these pathogens were not detected, indicating that the antimicrobial effect of chitosan ascorbate. All women had normal vaginal microflora, increased contents follow that warns the ascending route of infection of the uterus.

All women after treatment by the proposed method without delay came menstruation, mild, painless, which may also testify about the effectiveness of treatment of chronic oophoritis.

During the treatment in the second group of women pain in the pelvis is not docked on the 7th day of treatment, 30% women, 10 day 10%. Tenderness to palpation of the appendages bimanual study was maintained for 5 days at 50%, and on day 7, 30% of women. Limited mobility appendages detected on day 7 40%10 20% of women. Limiting the mobility of the uterus was preserved for 7 days at 40%, for 10 days 20% of women. The uterus in position retroflexio was maintained for 10 days at 30% of women. PDE has reached normal by 10 days of treatment that meet edelstam on a longer course of infectious-inflammatory process in comparison with the first group. In the dynamics of observations (within 2 months) and in 60% of women after treatment remained menstrual function: menstruation was painful, abundant and occurred with a delay.

The number of treatments depends on the presence of signs of recovery and achieve a stable therapeutic effect: complaints of the patient; gynaecological examination; ULTRASOUND studies; normalization of peripheral blood counts; the normalization of the measure of the deformability of erythrocytes; the assessment of the degree of frequency of the vagina, the duration of treatment averaged 7-8 days.

Clinical example. Patient D. 40 years old, came to the antenatal clinic at the place of residence 20.10.04. complaining of persistent pain in the lower abdomen, aggravated by physical activity, with irradiation in the lumbar region, sacrum; menstrual dysfunction in type algomenorrhea, hypermenorrhea; on painful discomfort during intercourse, infertility for 4 years. From the anamnesis it is known, suffer from chronic oophoritis for 9 years, said stable exacerbation of 2 times per year. Gynecological surgery was not. In 1978, the patient was performed laparotomy for acute appendicitis, of peritonitis. Gynecological survey found: hyperemia of the mucous membrane of the vagina and cervix moderate pain when s is lazii of the uterus, a significant limitation of mobility of the uterus and uterine palpation, tyazhistye the structure of the appendages of the uterus in position retroflexio, shortening of the vault of the vagina, the allocation of Beli. In the study of the vaginal discharge smear method (gram stain)detected: epithelial cells entirely, leukocytes 20-25 p/SP. When culture: the growth of normal microflora. In the clinical analysis of blood ESR - 15 mm/h, PDE - 14%. When ULTRASOUND of the genital organs: the uterus in position retroflexio, the increase in size of the ovaries, a small amount of free fluid in papadimitrou space. Was diagnosed with chronic salpingo-oophoritis in the subacute stage, about which were galvanized with the electrodes on abdomino-sacral technique, the power current of 10 mA for 15 min, after preliminary sanitation vulva and vagina furatsilina 1:5000 vaginally on a sterile swab was introduced 2% gel of chitosan ascorbate, containing metronidazole at 2 mg/ml temperature 36-38°1 time per day immediately prior to galvanization. After the conducted treatment, the woman had no complaints, pain was arrested on the 5th day, palpation painless appendages absent for 5 days, a significant increase in motility appendages match is - on the 7th day of treatment, on the 8th day of the uterus was determined in position anteflexio, arches vagina free, no whiter in 5 days treatment. Normalization smear on flora: epithelial cells in 2-3 p/SP., leukocytes isolated, Gram (+) bacilli abundantly. PDE dynamics amounted to 5 days - 7%, 8 days - 4%. In the clinical analysis of blood ESR - 7 mm/H. With the examination of the patient through the month: there was no abdominal pain, menstruation without delay, painless, pain during intercourse, no. A vaginal examination set residual effects of adhesions in the pelvis. The recommended re-treatment through the month.

Thus, the proposed method for the treatment of chronic oophoritis allows the average to reduce the treatment time by 1.5 times (7-8 days vs. 11-12 in the control group), to reduce the duration of the treatment (15 minutes versus 20 minutes in the control group), to prevent the formation and to reduce adhesions in the pelvis, nausea chronic pelvic pain syndrome, to normalize the vaginal microflora, prevent ascending route of infection of the uterus, to restore menstrual function, significantly improve the quality of life of women, to provide persistent therapeutic effect.

Sources of information

1. Wpoty, L.G. Tumilovich. Reoperation is gynecology. Moscow, 2002, s-391.

2. VPU. Inflammatory diseases of the pelvic organs. J. Gynecology, 2001, No.3, pp.93-97.

3. Vaheseinaga, Tagetrov. Diagnosis, treatment and prevention of adhesions in the pelvis in women with tubal-peritoneal infertility. J. Gynecology, 2002, No. 2, p.58-62.

4. RF patent №2196562, A 61 H 33/02, A 61 N 5/02, A 61 H 39/00, 20.01.2003.

5. RF patent №2195249, A 61 H 39/00 A 61 N 5/02, A 61 H 33/00, 27.12.2002.

6. RF patent№2215556, A 61 N 1/31, A 61 N 2/04, 10.11.2003.

7. Bogdashkin N., A. Korobov, V. Krasnov, Palamarchuk A. Laser therapy in the complex physiotherapy of patients with a chronic salpingo-oophorite and a pain syndrome. //Proceedings of the 8th International Congress of the European medical laser Association (EMLA) and 1 Russian Congress of medical laser Association (RMLA), Moscow, may 23-26, 2001. - S-123, - Rus.; Eng. - ISBN 5-93139-087-1. - RU.

8. Sauvestre. Morphofunctional condition of the uterus in chronic inflammation and complex treatment using mud extract. Abstract. CMN T-2004, p.2.

9. Lagarkova. Comparative evaluation of the treatment of inflammatory diseases of the uterus with the use of different factors of physical action. Abstract. CMN T-2000, p.1-15.

10. Umichan, Iascinina, Pavithran. The deformability of erythrocytes from patients with acute and chronic renal failure//therapist. Arch. in 1986, No. 12, s-93.

11. Sigafoos. J. Akush and gynecology. 1977,No. 4, p.23-26.

The method of treatment of chronic oophoritis, including preliminary vaginal cleansing with an antiseptic solution with the introduction of the vagina medicines before electrotherapy, characterized in that as electrotherapy use galvanized duration of 15 min, while the electrodes are imposed on Bourne-sacral technique, and as a drug, just before galvanization, inject 15 ml of 2% gel of chitosan ascorbate temperature 36-38°containing metronidazole at a dose of 2 mg per 1 ml of gel, of the procedures performed 1 time per day, the treatment of 7-8 days.



 

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