Method for local treatment of inflammatory diseases of uterine cavity and device for implementing it

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine and medical equipment, namely to obstetrics and gynaecology, and can be used for the local treatment of inflammatory diseases of the uterine cavity. The method is implemented by inserting a waveguide of a presented device in a protection enclosure into the uterine cavity. A taper base of a narrow portion of the enclosure leans on an external orifice of the cervical uterus to prevent accidental perforation of the uterus. An infusion system regulator is used to set the spray supply of a therapeutic solution into an irrigation canal of the ultrasonic device. Thereafter ultrasonic vibrations are generated, and the uterine cavity is treated with the sounded therapeutic solution. The exposure length is 3-5 minutes at the ultrasonic vibration frequency of 25 kHz, infusion rate approximately 100-150 ml/min. The total infusion volume is not less than 300 ml. The ultrasonic treatment enables providing the continuous outflow of the uterine discharge. The device comprises an US generator, an acoustic assembly, the waveguide with the protection enclosure, the infusion system for the therapeutic solution supply. The acoustic assembly and waveguide comprises the irrigation canal. A working tip of the waveguide represents a short cylinder having a diameter greater than the rest portion. The irrigation canal of the waveguide has a diameter of 2 mm. The protection metal thin-wall enclosure has a crimped distal end and drain holes and represents two cylindrical elements of various diameters connected by a taper junction with milled grooves arranged so that to enable the fluid access to the working tip cylinder, the length of which makes no more than 3 mm.

EFFECT: inventions provide the effective cleansing of the uterine cavity from infected and necrotised tissues with improved comfort and safety of the procedure with using no endoscopic equipment, cervical dilation manipulations and uterine pre-probing.

2 cl, 3 dwg, 3 ex

 

The invention relates to medicine, in particular to obstetrics and gynecology, and relates to methods and devices for the treatment of inflammatory diseases of the uterus, namely, endometritis, postpartum and post-abortion complications.

The prevention and treatment of purulent-inflammatory diseases of internal genital organs is one of the most topical problems in obstetric-gynecologic practice.

Among the various inflammatory disease endometritis is one of the common forms. In the structure of postpartum inflammatory diseases of the share of endometritis have 80-90%, of which up to 30% of endometritis after cesarean section. According to domestic and foreign authors, the frequency in the postpartum period is 0.4 to 0.8% among the total number of mothers and 6.3-40% among patients with postpartum inflammatory diseases.

In the structure of infectious-inflammatory complications after artificial abortion endometritis for up to 30% of cases. The frequency of post-abortion endometritis ranges from 1.7 to 20% of cases (Serov C. N., 2008; Magomedov, H. A., 2007). Acute endometritis after abortion, passed in the chronic form, is a 14.6-19.2% and is often the cause of reproduction disorders in young women (Miller I.e., 2007; Jasveer V., 2007). Endometritis arise u-16% of women terminated her pregnancy.

One of the main causes of endometritis after delivery, abortion, surgery is infection of the uterus by the presence of the residues of the ovum. Infection most often penetrates into the uterus upward through during childbirth, abortion, intrauterine interventions, postpartum or post-abortion periods. However, even in bacterial contamination of the uterus endometritis develops not always. The severity and duration of the disease is largely determined by the prevalence of the process, the nature of the lesion and the type of the pathogen.

If bacteria in the blood serum and the remains of the ovum conditions are created so-called "thermostat", which contributes to the proliferation of microorganisms. Appointed in these cases, antibiotic therapy is not effective enough, because antibiotics from the blood fall in the uterus of a convolution of the blood and the remains of the ovum. This therapy is intended to prevent the spread of infection outside of the uterus. The termination of the infectious process contributes to the release of the uterus of infected and necrotic tissue.

Known methods of local treatment of endometritis slightly differ from each other and are in mechanical or instrumental remove INFI the new balances of the ovum during perfusion, the irrigation or drainage of the uterus.

There is a method of diagnosis and treatment of endometritis after delivery by hysteroscopy, which allows you to specify variant of endometritis, the presence of residues of the ovum, to wash the uterus from blood clots. Using solutions furatsilina 1:5000 or 0.5% chlorhexidine in the amount of 1-1,5 liters. Diagnosed remnants of the fertilized eggs are removed from subsequent careful curettage of the uterine cavity that is pathogenetically justified therapeutic measure. However, a single washing cycle, the uterine cavity is clearly not enough when the true treatment of endometritis, because not ensured subsequent removal of wound debris.

There is a method of treatment of endomyometritis by intrauterine lavage, which consists in the introduction into the uterus of the catheter, filling through the catheter in the uterine cavity medicinal solution by providing forced circulation of the drug solution through the rehabilitated the uterus (Winternitz catheter). However, this method requires a long time of the procedure. In addition, the laminar flow of the solution generated by this method does not have sufficient kinetic energy for effective sanitization of the uterine cavity and saturation of the endometrium medicinal substance.

From the local treatment of inflammatory diseases of female sexual sphere and device for its implementation known from the patent RU 2086275 C1. The method consists in the introduction into the uterus of a medicinal solution, in this case, initially extend the cervical canal, fill the uterine cavity drug solution through the channel is introduced into the uterine cavity of the distal part of the fiberoptic endoscope, which controlled seal the mouth of the fallopian tubes obturators, then instead of fiberoptic endoscope to inject lattice expander, coupled with a waveguide-tool, and implement a circular sounding the uterus through the medicinal solution in the energy of low-frequency ultrasound on exposure for 2-3 minutes. The infusion rate not less than 150 ml/min. and a Device for implementing the method includes an acoustic node, lattice extender, provided with a holder, a working tool in the form of a waveguide without the inner channel, the delivery system of the medicinal solution and the pneumatic system for sealing the fallopian tubes. This method allows you to carry out a qualitative reorganization of the uterine cavity, however, has significant drawbacks, namely:

- the need for manipulation by the expansion of the cervical canal, which increases the invasiveness of the procedure, and also slows down the process of closure of the cervical canal occurring on a background of treatment of endometritis, aimed at stimulation of inv is lucivna processes;

- the need for the use of endoscopic equipment increases the cost of treatment;

- the complexity of the procedure requires for its implementation the involvement of highly skilled medical personnel;

- this procedure is time-consuming, making it difficult for its wide use in hospitals with a large flow of patients.

As the closest analogue of the claimed invention, the selected device for the treatment of inflammatory diseases of female sexual sphere in the form of apparatus "Kineton MM (Ozone/NO-ultrasonic treatment technologies in obstetrics and gynecology. Methodical recommendations. Omsk - 2011, S. 12-19, Fig.4), which carried out the cavity lavage drug solution to flow into the cavity through a waveguide tool through the medicinal solution, lavitrano fluid, which automatically leads to the bubbling of the solution. The apparatus includes ULTRASONIC generator (Fig.4), the acoustic node, the waveguide-tool protective casing, an infusion system for supplying the medicinal solution (C. 19-20). Inside the acoustic node and waveguide-tool with a diameter of 4.5 mm made irrigation channel, and the working end of the waveguide tool made in the form of a short cylinder with a diameter slightly larger than the rest (the waveguide is a tool VI-17, S. 16). Protective is a cover made of thin-walled with zahlcovany distal end and drainage holes (Fig.9).

The use of the claimed invention is achieved technical result consists in increasing the efficiency of the outflow of fluid from the uterus during the procedure, the treatment of inflammatory diseases of the uterus "voiced" medicinal solutions, as well as increased convenience and safety of this procedure due to the presence of a protective casing of a special form with drainage holes, which performs several functions:

- protects the tissue from accidental contact and damage activated ultrasonic instrument;

- provides an effective outflow of fluid from the uterus during the procedure (to avoid the rising spread of infection as a result of increasing pressure in the uterine cavity above atmospheric and into the solution in the fallopian tube);

- allows you to safely enter ultrasonic instrument into the uterine cavity without the use of endoscopic equipment, manipulation expansion of the cervical canal and advanced sensing cavity of the uterus.

Applying the method of local treatment of inflammatory diseases of the uterine cavity using the proposed device, in which the conducting cavity lavage drug solution to flow into the cavity through a waveguide tool through the medicinal solution kawailani fluid, Otley is audica fact, through the cervical canal into the uterine cavity enter the waveguide-tool protective casing, with a cone-shaped base of the narrow side of the casing rests in the outer orifice of the cervical canal to prevent accidental perforation of the uterus, with control infusion system install jet flow of drug solution into the irrigation channel ultrasonic instrument, then launch ultrasonic vibrations and make processing of the uterus considered a medical solution for 3-5 minutes at a frequency of ultrasonic oscillations of 25 kHz and the speed of infusion of about 100-150 ml/min, the total infusion volume of not less than 300 ml, during ultrasonic processing provide continuous outflow of the contents of the uterus.

It is claimed also a device for implementing this method, containing the ULTRASONIC generator, an acoustic node, the waveguide is a tool with a protective case, an infusion system for the supply of a medicinal solution, within the acoustic node and waveguide-tool has an irrigation channel, the working end of the waveguide tool made in the form of a short cylinder with a diameter greater than the remainder, and a protective cover made of thin-walled with zahlcovany distal end and drainage holes, characterized in that correlational channel waveguide tool has a diameter of 2 mm, protective cover made of metal in the form of two cylindrical elements of different diameters connected by a conical transition, with progresirovanie grooves placed with access of fluid to the cylinder of the working end, the length of which is not more than 3 mm.

The invention is illustrated in the illustrations.

In Fig.1-3 is shown a device for ultrasonic treatment of the uterine cavity, where:

1 - ultrasonic generator;

2 - acoustic node;

3 - waveguide-tool:

4 - protective casing;

5 - a system for conveying drug solution;

6 is a flow regulator medicinal solution;

7 - fitting the acoustic node;

8 - internal irrigation channel acoustic node;

9 - internal irrigation channel waveguide tool;

10 - conical transition;

11 - uterus;

12 - heat shrink tubing;

13 - working end of the waveguide tool (short cylinder);

14 - grooves;

15 - drainage holes.

In Fig.2 shows the design of heat shrink tubing.

In Fig.3 presents the design of the protective casing and the waveguide tool.

Device for local treatment of inflammatory diseases of the uterus consists of the ULTRASONIC generator 1, the acoustic node 2 with attached ULTRASONIC waveguide-tool 3, the protective cover 4 and the system is neither to supply the medicinal solution 5 (Fig.1-3).

Supply system of the medicinal solution 5 contains the capacity for drug solution infusion system with roller the liquid flow regulator 6, which via a silicon element is connected to the fitting 7 acoustic node.

The acoustic node 2 has an internal irrigation channel 8, is designed to deliver fluid to the distal end of the ULTRASONIC waveguide-tool 3, also having a channel for irrigation 9. The presence of irrigation channel 8, passing through the unused areas of acoustic node 2, allows to effectively lead emitted during the operation of heat, and hence the long-term performance of the acoustic node without overheating at high powers. The acoustic node is airtight, allowing its widespread sterilization by autoclaving method.

ULTRASONIC waveguides tools 3 with internal irrigation channel 9 of small diameter (2 mm) allow for a moderate volumetric charges (100-150 ml/min) to obtain increased (in comparison with tools with holes of large diameters) the flow rate of the cavitation jet that provides the best laundering fibrin and necrotic tissue. In addition, at the specified diameter of the irrigation channel manages to retain small and the outer diameter of the ULTRASONIC instrument. This enables not only the be increased amplitude of vibration of the distal end of the ULTRASONIC waveguide is a tool (power cavitation jet, the intensity of the ozonation), but use a thin protective casing 4.

The protective cover 4 consists of two cylindrical element of different diameters, connected by a tapered transition 10. The outer diameter of the narrowest part of the casing (which is introduced into the cervical canal) may have a size of from 7 to 4.8 mm, length of the narrow part of the casing is equal to 4.5, see above dimensions protective cover allow the treatment of postpartum endometritis (7 mm), and to use this ULTRASONIC tool in gynecological practice (4.8 mm) without additional manipulation on the expansion of the cervical canal and advanced sensing the uterine cavity 11. To reduce injury to the channel with the introduction of the ULTRASONIC instrument distal portion of the casing tapering (swallowed). For the same purpose to the insertion into the cervical canal of the casing may okazyvatsya thin-walled PTFE heat shrink tubing 12, which increases the slip between the casing and the walls of the cervical canal, which makes it easier to introduce the instrument into the uterine cavity. Until the uterine cavity is not filled with the medicinal product, the main active factor is cavitating jet generated by the ULTRASONIC tool. In the process of filling the cavity of this factor is complemented by cavitation barbotirovat the receiving accumulated in the uterine cavity fluid, what motivates you to apply technical solutions to maximize the effectiveness of ozonation. To intensify the process of ozonation necessary to increase the area of contact of the ULTRASONIC tool 3 with the treated liquid, and to ensure the presence of steps (the transition from one diameter to another) at the distal end of the tool for a more intensive mixing of the liquid inside the cavity diverging from the ultrasonic instrument acoustic flows. To solve this problem, the distal end of the ULTRASONIC waveguide-tool 3 ends with a short cylinder 13 by a length of not more than 3 mm, i.e. slightly larger in diameter than the rest of it. Irrigation channel waveguide tool has a diameter of 2 mm, the protective cover 4 is made of metal in the form of two cylindrical elements of different diameters connected by a conical transition, with progresirovanie grooves placed with access of fluid to the cylinder of the working end, the length of which is not more than 3 mm due to the fact that the protective cover 4 profesionaly additional grooves 14 provides access to the fluid in the cavity of the cylindrical part of the ULTRASONIC tool 13. For effective sanitization of the uterine cavity it is necessary to provide sufficient "head" of the cavitation jet. The pressure that defines this head set is the height lifting capacity with a medical solution relative to the cavity. When a dense coverage of the insertion section cover in the cervical canal, if we do not take additional measures the pressure in the uterine cavity may increase to values determined by the height of a column of water supply system of the medicinal solution 5, which increases the risk of an ascending infection through the fallopian tubes. To eliminate this danger, in the protective casing 4 provided additional drain holes 15, through which is provided free outflow of fluid from the uterine cavity and equalizing the pressure in the cavity to almost atmospheric.

The inventive method using the above described device is as follows. Before the reorganization of the uterine cavity are dedicated to the processing of the cervix with an antiseptic solution, such as a 0.05% aqueous solution of chlorhexidine. Then produce ultrasonic treatment of the uterine cavity. To do this, to an ultrasonic generator 1 is connected acoustic node 2, to the fitting 7 acoustic node connecting the system to supply the medicinal solution 5. Then through the cervical canal into the uterine cavity is entered waveguide-tool 3 in the protective casing 4, while the cone-shaped base 10 narrow part of the casing abuts against the outer orifice of the cervical canal, which prevents the possibility of accidental perforation of the uterus as a result of excessively deep in the edenia tool into the cavity of the body. Next, control infusion system 6 install the jet flow of drug solution into the irrigation channel ultrasonic instrument 9. After this launch ultrasonic vibrations and make processing of the uterus considered a medical solution for 3-5 minutes at a frequency of ultrasonic oscillations of 25 kHz and the speed of infusion of about 100-150 ml/min, the total volume of infusion should be no less than 300 ml.

As a medicinal solutions you can use: 0,9% saline solution, including with the addition of 1% dioksidina in the ratio of 40:1, furatsilina 1:5000 or other

Supplied through ultrasonic instrument medicinal solution is converted by means of ultrasonic vibrations in a directed stream of "voiced" fluid, which contains many of cavitation bubbles filled with gas and/or steam. When processing of the uterine lining and the cavitating jet is high quality cleaning of infected and necrotic tissue. After filling the machined cavity medicinal solution, the impact of the cavitating jet supplemented cavitation bubbling liquid. The influence of cavitation bubbles and other factors of low-frequency ultrasound on the site of infection clears the wound from the surgery necro is practical mass, the mechanical destruction of bacteria, micro-massage underlying tissues, stimulation of reparative processes. Active chemical substances produced in the "voiced" fluid, have bactericidal activity against the causative agents of wound infections and stimulate redox processes in the tissues.

During ultrasonic processing ensures a constant outflow of the contents of the uterine cavity. The return fluid from the uterine cavity into the space between the ultrasonic tool and the protective casing and flows out through the drain holes in the casing. If the walls of the cervical canal loosely cover the protective cover, then drain fluid also occurs on the walls of the cervical canal. Concurrently, the internal irrigation channel ultrasonic instrument is a steady supply of fresh medicinal solution from the infusion system in the uterus.

After the procedure, turn off the generator of ultrasonic vibrations, stop the flow of drug solution from the infusion system, ultrasonic instrument, the protective cover is removed from the uterine cavity, the infusion system is disconnected from the acoustic node. The procedure is performed 1 time per day. The duration of treatment depends on the severity of the disease and in the middle of SOS is to place from 3 to 7 treatments.

According to the proposed method of treatment of inflammatory diseases of the uterine cavity using the device for its implementation in obstetric observational Department of the Central city hospital №7, Ekaterinburg were treated to 15 people with complications in the postpartum period. 5 of them are women entered the office with septic metroendometrit and 10 women with endometritis average and mild severity. Additional rehabilitation of the uterine cavity of the proposed device with the above parameters of influence helped to increase the effectiveness of treatment, to reduce the drug load on the patient, to decrease the percent of surgical rehabilitation of the uterine cavity, to reduce the duration of treatment is on average 2-3 times (depending on the severity of the disease). The procedure is well tolerated, safe and comfortable for the patient, does not require much time and material cost of its implementation

Example 1. Patient P. 26 years. Was admitted to the Department of post-partum infections with postpartum endometritis. Complaints of lower abdominal pain, bloody-pussy discharge from the genital tract, weakness, fatigue. Objectively the uterus is increased to 14-15 weeks of pregnancy, painful on palpation, the cervical canal pass for one finger for internal Zev, highlighting the tomato" flavor. Ultrasound examination showed an increase in the uterus to 154×108×112 mm, which is significantly higher than average for the postpartum period. The uterine cavity is expanded to 38 mm Studies on the microflora showed a massive growth of conditionally pathogenic flora (E. coli). Conducted 4 routine ultrasound treatment of uterine cavity with furatsilina 1:5000. Without anesthesia and without dilatation of the cervical canal, the waveguide is a tool in the protective cover was introduced for the internal orifice of the uterus. Next, the roller controller infusion system was installed jet flow of drug solution into the irrigation channel ultrasonic instrument, was launched ultrasonic vibrations and producing processing of the uterus considered a medical solution for 3 minutes at a frequency of ultrasonic oscillations of 25 kHz and the speed of infusion of about 100 ml/min, the total infusion volume was 300 ml. The patient during the procedure did not report any discomfort. On the first day after the end of the procedures, subjective pain, improved health. Objectively, the allocation of steel Muco-serous, uterus decreased to 7 weeks of pregnancy, the inner mouth closed, which was confirmed by ultrasound examination. Seed funding on the microflora showed no growth BA is clear. Extract the patient made on the 7th day. Standard antibiotic therapy in conjunction with physical therapy, even after curettage of the uterine cavity on the background hysteroscopy leads to positive results not earlier than 7 days, and delays the timing of the statement.

Example 2. Patient C. for 27 years. Translated from the hospital for 8 days with a diagnosis of endometritis after cesarean section. Bothered dragging pain in the abdomen, "tomato" discharge from the genital tract with the smell, fever of 37.8°C. When the survey found an increase in the uterus for up to 16 weeks. The uterus is softish texture, painful on palpation, the internal orifice of the cervix freely passes 2 exploring finger. In the analysis of a smear leucocytes up to 70 in sight, coccal flora. In seed funding on the microflora found abundant growth of Escherichia coli. The result of the ultrasound examination of the uterus 162×82×144 mm, endometrium 19 mm, infiltration of the myometrium, fibrin clots. Conducted manual vacuum aspiration of the uterus. Low-frequency ultrasound treatment of uterine cavity with furatsilina 1:5000 was performed 5 times daily. Without anesthesia and without dilatation of the cervical canal, the ultrasonic waveguide is a tool in the protective cover was introduced for the internal orifice of the uterus. Next, using Raikovo the regulator infusion system was installed jet flow of drug solution into the irrigation channel ultrasonic instrument, started ultrasonic vibrations and producing processing of the uterus considered a medical solution for 3 minutes at a frequency of ultrasonic oscillations of 25 kHz and the speed of infusion of about 100 ml/min Sensations during the procedure, the patient was noted as comfortable. On the third day from the beginning of the procedures subjectively decreased pain, improved health. Objectively, normalized temperature, separation became blood, the uterus was reduced to 10 weeks of pregnancy, the inner mouth closed. On the 7th day the uterus is reduced, the cavity it closed, which was confirmed by ultrasound examination. The patient was discharged on the 9th day. Endometritis after cesarean section is a serious complication and can lead to organ removal. The average treatment time with this pathology are 21 days. Thus, the application of this treatment significantly reduces the time of treatment of patients with endometritis.

Example 3. Patient K. 37 years. Came from a maternity hospital on the 4th day after spontaneous labour with a diagnosis of puerperal septic endometritis. Worried about the pain in the lower abdomen, bleeding from the genital tract, weakness. Objective: the uterus is increased to 12 weeks, softish, internal Zev skips the tip of your finger. Sowing detachable on the microflora showed abundant growth entero is occus fecalis. Ultrasound examination showed an increase in uterine 125×85×105 mm, the endometrium is thickened to 22 mm, a large amount of fibrin. Conducted 3 treatments of low-frequency ultrasound treatment of uterine cavity with the aforementioned method with furatsilina 1:5000. By the end of treatment were all subjective sensations. Ultrasonic testing conducted on the 5th day confirmed the reduction of the uterus to normal size, the endometrium has become homogeneous, the uterine cavity is closed. Thus, the use of ultrasonic treatment of the uterine cavity with antiseptic solutions when endometritis leads to a significant reduction of treatment time and reduces the possibility of aggravation of the inflammatory process and the need for subsequent surgical treatment of women.

1. The method of local treatment of inflammatory diseases of the uterus, which spend cavity lavage drug solution to flow into the cavity through a waveguide tool through the medicinal solution kawailani fluid, characterized in that the exposure is carried out with the use of the device under item 2, through the cervical canal into the uterine cavity enter the waveguide-tool protective casing, with a cone-shaped base of the narrow side of the casing rests in the outer orifice of the cervical canal to prevent accidental perforation of the uterus, via the regulator is ora infusion system install jet flow of drug solution into the irrigation channel ultrasonic instrument, after this launch ultrasonic vibrations and make processing of the uterus considered a medical solution for 3-5 minutes at a frequency of ultrasonic oscillations of 25 kHz and the speed of infusion of about 100-150 ml/min, the total infusion volume of not less than 300 ml, during ultrasonic processing provide continuous outflow of the contents of the uterus.

2. A device for implementing the method according to p. 1 containing ULTRASONIC generator, an acoustic node, the waveguide is a tool with a protective case, an infusion system for the supply of a medicinal solution, within the acoustic node and waveguide-tool has an irrigation channel, the working end of the waveguide tool made in the form of a short cylinder with a diameter greater than the remainder, and a protective cover made of thin-walled with zahlcovany distal end and drainage holes, characterized in that the irrigation channel waveguide tool has a diameter of 2 mm, a protective cover made of metal in the form of two cylindrical elements of different diameter, United conical transition, with progresirovanie grooves placed with access of fluid to the cylinder of the working end, the length of which is not more than 3 mm.



 

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1 tbl

FIELD: medicine.

SUBSTANCE: composition 16-21ml consisting of a mixture of therapeutic preparations: Dona glucosamine sulphate 3.0 ml; ChondroGuard, or Mucosatum, or Chondrolon chondroitin sulphate - 2.0 ml; Alflutop 2.0 ml; Actovegin 4.0-5.0 ml; glucocorticosteroids Depo-Medrol 1.0-2.0 ml in the concentration of 40 mg/ml, or Diprospane 1.0-2.0 ml in the concentration of 7 mg/ml, or Metipred 1.0-2.0 ml in the concentration of 62.5 mg/ml; vitamins B1, B6, B12 Combilipen 2.0 ml, or Milgamma 2.0 ml, or Neurobion 3.0 ml; 95% or 70% ethanol 2.0-4.0 ml, is administered into a pathologically changed region. That is immediately followed by exposing the pathologically changed region and adjoining segments to a session of A shock-wave therapy in the following mode: pressure 1.2 - 4.0 bar, frequency 7-12 Hz, beat quantity 8000-14000 for 20-40 minutes. The complex procedures are performed within the course of 1-6 times every 7-10 days.

EFFECT: method enables the direct exposure on the pathologically changed region to achieve the optimum concentration of drug preparations therein with avoiding systemic prescription and preventing a risk of side effects.

3 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: method involves a course of 5-7 pulse ultrasonic procedures having an intensity of 0.2-0.4 W/cm2 of 5-7 minutes daily. That is combined with enzyme therapy with Longidaza 3,000 units 2 times a week for 1 month. Besides, Trilon B rectal suppositories 1,000 mg and Dimexidum 200 mg are administered daily for the night for 3 months. The bacteria are detected by a microscopic and microbiologic examination of ejaculate that is followed by a 4-6-week antibacterial therapy by administering an antibacterial preparation taking into account the microflora sensitivity.

EFFECT: such implementation of the method provides removing the prostate stones or decreasing the number thereof, reducing a probability of the inflammatory process in the prostate, ensuring a differentiated therapeutic approach by detecting the group of patients whom the antibacterial therapy is indicated to.

3 cl, 3 ex

FIELD: medicine.

SUBSTANCE: pathogenetic treatment of chronic tonsillitis and/or hypertrophy of palatine tonsils in preschool children suffering from lymphoproliferative syndrome is ensured by the palatine tonsils debridement. An interleukin-1β(IL-1β) level is measured in the palatine tonsils washing. If the measured value is less than 5.8 pg/ml, recombinant interleukin-1β (IL-1β) is to be administered orally by phonophoresis with the use of the Tonsillor MM apparatus. Two courses of 10 procedures every 14 days are performed. The clinical effectiveness is assessed if observing a positive dynamics of IL-1β measured in the palatine tonsils washing 17 and 41 days after the beginning of the immunomodulatory therapy.

EFFECT: higher clinical effectiveness ensured by the differentiated selection of children for carrying out the immunomodulatory therapy, reducing a rate of infectious involvements of the palatine tonsils in the declared group of patients by the pathogenetically reasoned application of recombinant IL-1β.

3 cl, 2 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: method involves the combined exposure to ultrasound and electric current on a projection of the bladder. The ultrasonic exposure is carried out at the intensity of 0.2-0.4 W/cm2, frequency of 1 to 3 MHz. The electric pulse exposure involves amplitude modulated current in the frequency range of 100-250 Hz, at a basic frequency of 5-8 kHz for 10 minutes. The therapeutic course involves 8-12 procedures.

EFFECT: method prevents such complications of the bladder dysfunctions, as vesicoureteral reflux, chronic inflammatory renal and urinary diseases.

1 ex

FIELD: medicine.

SUBSTANCE: palatal tonsils are daily sanitated with antibacterial preparations selected in accordance with the bacteriological examination of oral smears for pathogenic microflora and antibiotic sensitivity with the tonsil lacunae washed for 10 days. Pre-anaesthesia is followed by the tonsil lacunae exposure to an ultrasonic disintegrator at a depth of a probe working area at an amplitude of 23-26 mc every second day for 5 days. That is followed by paratonsil administration of polyoxidonium in an adult dose of 6 mg every second day for 5 days; the therapeutic course is performed once a year.

EFFECT: method enables higher clinical effectiveness in chronic tonsillitis.

2 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: placenta hydrolyzate 1 ml mixed with lanolin 30 g before the procedure is applied on an anterior abdominal wall of a patient lying on his/her back in the projection of adhesions. That is followed by phonophoresis generated by UZT-1.07F ultrasonic therapeutic apparatus and sounded by an emitter of the diameter of 4 cm of the intensity of 0.4-0.6 W/cm2. The exposure mode is continuous; an emitter velocity is 1-1.5 cm/sec. The length of procedure is 5-7 minutes. The therapeutic course is 10 procedures.

EFFECT: reduced progression of abdominal adhesions and their manifestations by evident anti-inflammatory effect, reduced pain syndrome, higher adaptive body reserves.

3 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: before the implantation, a demineralised bone graft (DBG) is kept for 2 hours in 0.9% chloride solution at room temperature. Thereafter, the DBG is exposed for 10 minutes to ultrasound at frequency 44±4.4 kHz and vibrational amplitude 30 to 50 mcm in 0.9% sodium chloride solution heated to 36°C.

EFFECT: method enables accelerating the repair processes in grafting a fragment of the demineralised bone graft of the pre-set shape in experimental animals and increasing substantially post-grafting osteogenesis rate in a segment of a skull flat bone.

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to prevention of purulent-septic inflammatory complications in obstetric patients of a high infectious risk group. A device comprises an ultrasonic generator with a monitor control, a piezoceramic radiator with a terminal wave guide and an intravenous medication system with a control valve, a pivotally connected system of equally spaced support nuts, supplementary ultrasonic generators with monitor controls and piezoceramic radiators built into the nuts; with a quantity of the piezoceramic radiators matching a quantity of the nuts laid on a spacer, a programmed microcontroller and an indication panel. The piezoceramic radiators are fixed on the support nuts of the pivotally connected systems, flow through spacer holes and are connected to outputs of the respective ultrasonic generators the monitor controls of which are connected to matched outputs of the programmed microcontroller which are simultaneously connected to matched inputs of the indication pane and the control valve of the intravenous medication system.

EFFECT: providing individual spatial characteristic of the effect and higher reliability.

3 cl, 2 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to ultrasound therapeutic apparatuses. An ultrasonic transducer contains at least one ultrasonic radiating element with ultrasonic wave front sets radiated by the element representing spherical surfaces of the same radius, while the ultrasonic radiating element performs a function of ultrasound reflection and forms a spherical resonant cavity. If using more than one ultrasonic radiating element, they are configured to form a combined spherical resonant cavity. An internal space of the spherical resonant cavity is shaped as a full spherical envelope or a truncated spherical envelope with a sphere centre inside, while the ultrasonic waves generated by at least one ultrasonic radiating element are focused in the area which comprises the sphere centre of the spherical resonant cavity.

EFFECT: using the invention provides an ultrasonic focus energy gain, as well as eliminated working frequency influence of an ultrasonic source.

15 cl, 11 dwg

FIELD: medicine.

SUBSTANCE: area of inflammation is exposed to ultrasound generated by the Sonoca 185 apparatus. The exposure power gradually grows within the range of 20 to 40-80 W depending on age. The palatal tonsils are alternately sanitised with octenisept dissolved in 0.9% sodium chloride in a ratio 1:8 with an octenisept flow rate gradually increasing within the range from 20 to 180 ml/s, an exposure time of 2-5 seconds for 3-5 minutes. The therapeutic course is 8-10 sessions, either daily or every second day.

EFFECT: method involves the integrated effect of ultrasound and antiseptic on the oropharyngeal mucosa in the developed regimen that enables providing the higher therapeutic effectiveness, including that in children suffering from chronic tonsillitis, reducing a probability of complications, improving an acceptability of presented therapy.

3 ex

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment, namely to means of carrying out low-invasive surgical operations. A surgical ultrasonic instrument contains coordinating and conducting elements for the transmission of an ultrasonic signal and a working end connected to the conducting element. The conducting element and/or working end have at least one section with different physical and/or mechanical properties, obtained by performing its thermal and/or mechanical treatment or made from a material, different from the material of adjacent section(s). A device for the ablation of a pathological mass additionally contains a generator of ultrasonic fluctuations and an acoustic unit. The method of the pathological mass ablation from a biological tissue consists in the application of the device for the pathological mass ablation.

EFFECT: improvement of transmission of ultrasonic fluctuations, provision of sufficient dynamic stability of the ultrasonic instrument and control of the curvature of a trajectory of elastic deformation of the conducting element and working end of the ultrasonic instrument.

27 cl, 13 dwg

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