Application of blood photomodification in complex therapy of vaginal candidosis

FIELD: medicine, gynecology.

SUBSTANCE: one should carry out intrauterine photohemotherapy with the help of special equipment for 45-50 min, 5 seances. Moreover, for interrupting acute manifestations of vaginal candidosis it is necessary to conduct therapy with antimycotic preparations once daily for 3 d, and since the 3d-4th d one should perform intrauterine photohemotherapy every other day at the mode "II", after photohemotherapy it is useful to continue antimycotic vaginal therapy for 3 d more. For treating chronic, relapsing forms of vaginal candidosis therapy with antimycotic preparations should be fulfilled locally every other day by alternating it with intrauterine photohemotherapy at modes "II" and "III". In 1.5-2 mo after the course of therapy it is suggested to carry out repeated course of intrauterine photohemotherapy at the mode "III", every other day, 5 seances.

EFFECT: higher efficiency of therapy.

1 cl, 1 ex

 

The invention relates to medicine, namely to gynecology, and can be used to treat vaginal candidiasis.

Currently, there is a steady increase in the incidence of Candida infections. This is due to many factors: the impact on the human body changing environment, prolonged and uncontrolled use of antibiotics, corticosteroids, cytostatics, immunodeficiency States. Vaginal candidiasis is one of the most common manifestations of candidiasis, registered an average of 75% of women. Feature modern vaginal candidiasis is a long period of transition in relapsing forms. Most often affects women of reproductive age, in addition, vaginal candidiasis can occur in menopause and in childhood. For candidal infection is characterized by the presence of extragenital lesions (in the oropharynx, gastrointestinal tract), which exacerbates the course of vaginal candidiasis. Currently, treatment of vaginal candidiasis are used antimycotic drugs local and systemic action. Drugs local actions use pimafucin, clotrimazole, Gino-travogen and others, some authors propose to use the local influence of the laser radiation (KOREPANOV V.I. Laser therapy in obstetrics, gynecology, urology, Nephrology and proctology. M., 1998, p.20-21). Drugs for systemic effects include diflucan, Orungal, and others, and the duration of medication treatment can last up to 6 months. This treatment method has several disadvantages:

1. Funds General steps contraindicated in pregnancy, possess a nephro - and hepatotoxicity, cause allergic reactions, abnormal function of the gastrointestinal tract.

2. The most used antimycotic drugs causes suppression of the normal microflora of the vagina and intestines. There is a necessity to additionally use eubiotics, biogenic stimulators, vitamins, immunomodulators and other facilities conducive to the normalization of microflora of the vagina and intestines, broken antimycotic drugs.

3. To achieve stable remission requires long-term use of antimycotic drugs (3-6 months).

These problems in the treatment of vaginal candidiasis require a search for new, more effective methods to achieve good results in the treatment and prevention of relapses.

We have developed methods and intrauterine intravascular blood photomodification uses machine series HVAC-3 in certain modes (spectral range of 280-600 nm, the capacity of optical fiber is sky radiation at the end of the optical fiber 5 to 80 mW). The mode "I" allows you to photomodification blood part of long-wave ultraviolet (365-400 nm) and the predominantly visible light (400-600 nm). Mode "II" enables photomodification blood mainly to the long-wavelength ultraviolet radiation (315-400 nm) and visible light of 600 nm. Mode III provides the effect on blood mainly ultraviolet spectrum of optical radiation (280 to 400 nm).

For relief of acute manifestations are assigned antimycotic agent of local action in the form of vaginal suppositories (1 suppository vaginally 1 time a day for 3 days). At the same time carried out an additional survey of women (CBC, RW, HBsAg, prothrombin). With 3-4 days connected intrauterine photomodification blood. The patient is laid on the examination table, with uterine probe determines the patency of the cervical canal, its direction and size of the uterine cavity. Taking into account the received data sterile optical fiber is inserted through the cervical canal into the uterine cavity 1-2 cm behind her cervix. Fixation of the fiber is carried out by adhesive tape to the inner thigh. The procedure is recommended at intervals through the day, 5-7 sessions per course of treatment. The duration of the procedure 45-50 minutes. More effective is the use of "II" mode on the unit HVAC. The settlement of the e end of photochemotherapy assigned vaginal antifungal therapy (1 vaginal suppository 1 time a day for 3 days) followed by conventional control studies (DAB content vagina, culture, PCR). To prevent recurrence of the disease after 1.5-2 months a prophylactic course of intrauterine photochemotherapy apparatus HVAC mode "III" 5 sessions of 45-50 minutes each with an interval of a day. For the treatment of chronic, recurrent forms after a full examination, we recommend the following scheme: at intervals through the day to local treatment with antimycotic drugs (1 vaginal suppository 1 time per day) in alternation with the intrauterine photochemotherapy using the apparatus of the HVAC. Using modes "II" and "III" for 20-25 minutes on each mode, and the total treatment time is also 45-50 minutes. Required for a course of 5 sessions photochemotherapy. 2 months is a control examination of the woman and depending on results or repeats the above-described treatment, or is only photochemotherapy from relapse in order according to the methods of preventive course described above. Thanks to the peculiarities of the influence of blood photomodification uses on indicators of homeostasis in women with the inclusion of this method in the complex therapy of vaginal candidiasis is not required destination antimycotic funds systemic action.

EXAMPLE. Patient L., aged 26, complaints of itching, burning, cheesy vaginal discharge with an unpleasant, sour sophomorichumor: General condition is satisfactory. AD-120/70 mm Hg, heart rate of 76 beats per minute, satisfactory qualities. Examination of the vagina in the mirror: the vaginal mucosa hyperemic, swollen, covered with grayish-white bloom, highlighting abundant with cheesy-roscovitine inclusions. Analyses before treatment: complete blood count - er; HB 118 g/l; CPU 0,9; leukocytes 9000; e 2, P 8, L 28, 56, M 7, ESR 26 mm/h According to the stroke, seeding, Poland known C. Albicans. Diagnosed with vaginal candidiasis, acute form.

As of the preparation of the local action was assigned pimafucin on 1 suppository vaginally 1 time a day for 3 days. From the 3rd day began to hold intrauterine photomodification blood mode "II" apparatus HVAC, through the day, just 5 sessions of 45 minutes each session. From the 3rd day of treatment noted marked reduction in redness, swelling, itching. After photochemotherapy another 3 days was appointed pimafucin (vaginally 1 candle 1 time per day). After the 5th session photochemotherapy she recovered, disappeared cheesy discharge. No complaints. The presence of Candida infection according to the stroke, bacteriological seeding is not revealed. Complete blood count - er 3600000; HB 118 g/l; CPU 1,0; leukocytes 7700; e 1, P 2, L 25, 64, M 5, erythrocyte sedimentation rate of 13 mm/h 1.5 months was conducted anti-relapse intrauterine photochemotherapy using the apparatus of the HVAC mode "III", just 5 sessions of 45 minutely intervals through the day. Control tests were carried out after 6 months, the presence of Candida infection is not identified.

All were surveyed 210 women. All patients were divided into 2 groups - primary (132 patients) and control (78 patients). In the control group received standard scheme of drug therapy using drugs with systemic effects, but in the main group were carried out by local treatment with antimycotic drugs in combination with intrauterine photomodification blood. Follow-up of women was carried out after the end of treatment and after 6-8 months. As a result, the inclusion in the complex therapy of intrauterine photochemotherapy in the respective modes of the optical radiation can significantly reduce the number of recurrent candidal infection. In addition, patients of the main group are not signs of toxic effects on the body antimycotic drugs, as they were used only locally and within a short time.

Used in the treatment of vaginal candidiasis modes "II" and "III" of the HVAC-03 manifested by specific changes in indicators of homeostasis: activation of cellular and humoral immunity, normalization of blood rheological properties, normalization of acid-base status (KOS) and transmission function is of the blood, activation of hematopoiesis, a pronounced anti-inflammatory and antihistaminic effects. These clinical effects of photochemotherapy, normalizing metabolism and immune function, improve the efficiency of antimycotic drugs. In addition, the use of photochemotherapy promotes reduction of comorbidities and other risk factors of recurrence of the infection.

CONCLUSION.

Thus, the proposed method of complex treatment of vaginal candidiasis in women improves the efficiency of the treatment of vaginal candidiasis due to the persistent effect of recovery, reduce the number of relapses of the infection. The application of this method shows high biological effect, improves the quality of life of patients.

1. The method of complex treatment of vaginal candidiasis in women through a combination of antimycotic funds and phototherapy, characterized in that the intrauterine photochemotherapy carried out using an apparatus HVAC for 45-50 min 5 sessions, and for relief of acute manifestations of vaginal candidiasis treatment antimycotic means carry out 1 time per day for three days, and spend 3-4 days intrauterine photochemotherapy through the day mode "II", after photochemotherapy three days spend antimycotic of vaginal the Yu therapy for the treatment of chronic, recurrent forms of vaginal candidiasis treatment antimycotic means spend locally intervals every other day, alternating with intrauterine photochemotherapy in the "II" and "III".

2. The method according to claim 1, characterized in that after 1.5-2 months after treatment, the course is repeated intrauterine photochemotherapy apparatus HVAC mode "III" through day 5 sessions.



 

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