RU2077306C1 - Method to treat inflammation of uterine appendage in women with hyperpolymenorrhoea - Google Patents

Abstract

FIELD: medicine, gynecology. SUBSTANCE: method deals with CMT phoresis with 5%-ethylaminocapronic acid above projection area of uterus and uterine appendage at straightened regime ranged 100-60 hertz for 20 minutes daily during the first five days, then it should be alternated by balneotherapy conducted in a day at normal ovarian function or two days running at 1 day interval at initially decreased ovarian function. EFFECT: higher efficiency of therapy. 5 tbl

Description

 The invention relates to medicine, namely to gynecology, and can be used in the rehabilitation of the most common contingent of gynecological patients.

Known methods of treating women with inflammation of the appendages, including those at hydrogen sulfide resorts, where the treatment is based on hydrogen sulfide balneotherapy [1]
However, hydrogen sulfide balneotherapy is not prescribed at all or is limited in women with VZOT and increased menstrual hemorrhage such as hyperpolymenorrhea due to fear of increased possible proliferative processes in the endometrium or cervix. In addition, prolonged menstruation reduces the number of possible balneotherapy procedures, especially vaginal irrigation, which, with the existing treatment period of 24 days and the duration of menstruation 5 days, only 19 days are left for full treatment.

 The purpose of the invention is the reduction of treatment time and the expansion of indications for hydrogen sulfide balneotherapy.

 This goal is achieved by the fact that hydrogen sulfide balneotherapy is carried out against the background of SMT-phoresis of epsilonaminocaproic acid (EAAA).

 The method is as follows.

 Treatment begins with 5 daily SMT phoresis procedures of a 5% EAAC solution on the hypogastric region. The impact is carried out in the straightened SMT mode, lasting 20 minutes: genus I (PM), frequency 100 Hz 4 minutes: genus III (PN), frequency 80 Hz 10 minutes, genus IV (IF), frequency 60 Hz 6 minutes. The modulation depth increases in the range of 25-100% to an analgesic effect. From the 4th day of treatment with SMT-phoresis, EACC is combined with hydrogen sulfide balneotherapy, which is carried out every other day with normal or 2 days in a row with a break day with initially reduced ovarian function. Patients with normal ovarian function receive a course of 8 balneological procedures and 12 SMT-phoresis of EACC, with hypofunction of the ovaries, respectively, 10 procedures. Hydrogen sulfide balneotherapy is carried out in the form of vaginal irrigation (100-150 mg / l of hydrogen sulfide at a water temperature of 38-40 degrees, a duration of 15 minutes and shared baths at a concentration of hydrogen sulfide of 50-150 mg / l from 6 to 15 minutes.

 Scheme vacation procedures are presented in table 1.

 Treatment by the proposed method is carried out for 19 days, in 1-3 days of menstruation, only vaginal irrigation is excluded.

 If possible, it is better to start treatment 7-10 days before the next menstruation or with its beginning.

 Epsilonaminocaproic acid (EACA) is a pathogenetic treatment for women with inflammation of the appendages and increased menstrual blood loss (hyperpolymenorrhea). This is due to its antienzyme activity, in particular the ability to inhibit fibrinolysis, as well as the suppression of kinin activity and the stimulation of immunological reactivity factors.

 The good penetrating ability of the EACC from the anode to the cathode with the preservation of all pharmacotherapeutic properties is enhanced by the therapeutic properties of SMT (improved hemodynamics, normalization of tissue trophism with intensified metabolic processes with analgesic and sedative effects) and hydrogen sulfide balneotherapy.

 An example of a specific implementation of the method.

 Patient P. 29 years old, medical history N 2221, was admitted to the clinic of the institute with a diagnosis of bilateral chronic adnexitis (exudative-adhesive form), hyperpolymenorrhea, pelvic neuralgia. Infertility II. Bacteriuria.

 Considers herself a patient from 25 years of age (the beginning of regular sexual activity), when against the background of prolonged (7-10 days) and heavy menstruation, hemorrhage appeared, which lasted 3 weeks. Diagnosed with inflammation of the appendages. The treatment was carried out in a hospital. Menses remained long (8-10 days, sometimes up to 14). A year later, there was an examination of the inflammatory process without an increase in temperature. In the last two years, he has been treated for secondary infertility. At 19, she was pregnant, interrupted by a medical abortion.

 The main complaints at admission: prolonged menstruation, intermittent pain in the lower abdomen, infertility.

 When examined in the institute’s clinic: the cervix is without features, the uterine body is not enlarged, displacements are limited by commissures, the ampullor sections of the tubes are enlarged, in commissures, the ovaries are not isolated in isolation. Pain in the sacrum of the piriformis, obturator openings is expressed.

Blood test: color index 0.77, red blood cells 4.54x10 ¹² / l, hemoglobin 116.7 g / l, ESR 4/6 mm 1-2 hours, white blood cells 6.2x10 ⁹ / l, eosinophils 5, monocytes 5, p I am 3, s / I 46, lymphocytes 41.

 Urinalysis: white blood cells 8-10 in the field of view, bacteria, otherwise the limits are normal.

 ECG without features.

 Proteingram: total protein 95.4 g / l, globulins 39.7% A / G coefficient 1.52 (norm 1.3-1.35), alpha-1-globulins 3.6% alpha-2-globulins 6, 5% betta globulins 8.8% gamma globulins 20.8% ceruloplasmin 0.23 g / l, alpha-1-antitrypsin 6.24 g / l, alpha-2-macroglobulins 1.13 g / l.

Immunogram: white blood cells 6.5x10 ⁹ / l, lymphocytes 38% T-lymphocytes 85% B-lymphocytes 26% T-helpers 18% T-suppressors 67% immunoglobulins: C 8.6 g / l, A 2.4 g / l M 2.7 g / l.

 Changes in the immune status are assessed as an imbalance of immunoregulatory cells with activation of T-suppressors.

Pelvic rheogram within normal limits, with the exception of alpha / T, 20% in healthy subjects up to 18%
After minimal adaptation on the 2nd day after admission to the clinic of the institute, which corresponded to the 21st day of the menstrual cycle, the patient started treatment by the proposed method. On the first five days of treatment (21-25 days of the cycle), SMT-phoresis of a 5% solution of EACA was prescribed (a sick decrease in pelvic pain was noted by the 4th day of treatment). From the 4th day of treatment, in addition to the CMT phoresis, she received hydrogen sulfide balneotherapy in the form of vaginal irrigation at a concentration of hydrogen sulfide of 150 mg / and a total bath at a concentration of hydrogen sulfide of 50 mg / l. The patient received alternating physiotherapy and hydrogen sulfide balneotherapy alternating every other day.

 The next menstruation began on the 30th day of the cycle. Before her, the patient received 7 procedures for SMT-phoresis of EACC and 3 procedures for hydrogen sulfide balneotherapy. On the days of menstruation, which was reduced to 4 days, only vaginal irrigation was missed. The treatment was completed for 19 days in the clinic, which corresponded to the 9th day of the next cycle. Discharged with significant improvement.

Blood test: color indicator 0.92, er. 4.67x10 ¹² / l, HB 141.7 g / l, COE 5/12 in 1-2 hours, lake. 6.6x10 ⁸ / l, eosin. 1, mon.-5, s / s-4, s / s 58, lymph. 32% (complete normalization of red and white blood).

 Urinalysis: within normal limits.

 Proteinogram: total protein 88.4 g / l, globulins 44.7% A / G 1.24, alpha-1-globulins 5.4% alpha-2-globulins, 8.8% beta-globulins 10.9% gamma β-globulins 19.6% ceruloplasmin 0.235 g / l, alpha-1-antitrypsin 6.5 g / l, alpha-2-macroglobulin 1.23 g / l.

Immunogram: white blood cells 6.7x10 ⁹ / l, lymphocytes 37% T-lymphocytes 84% B lymphocytes 7% T-helpers 30% T-suppressors 54% immunoglobulins: C 9.0 g / l, A - 3.66 g / l , M - 0.9 g / l.

 In the immunogram, as in the protein spectrum, positive dynamics is clearly expressed with the normalization of the level of B-lymphocytes and indicators of humoral immunity, with a distinct tendency in the balance of immunoregulatory cells. Positive changes were also noted in the blood supply in the pelvic basin, the vascular tone decreased to 15.8% (with normal blood supply and venous outflow).

 The residual diagnosis at discharge of the patient: infertility II.

 According to long-term results after 6 months: no complaints, menstruation takes 4-5 days, moderately, regularly.

 Thus, the proposed method of treatment is the method of choice in the treatment of women with inflammation of the appendages and hyperpolymenorrhea.

 The proposed method was applied in 37 women aged 22-36 years, in 86.5% of which there was bilateral (in the others, unilateral) inflammation of the uterus, 86.4% of them suffered from heavy (or) prolonged menstruation with menstrual irregularities 40.5% of the examined, with 21.6% of these disorders developing due to inflammation, the rest preceded the clinical detection of the inflammatory process, while 32.4% of women had primary and 54.0% secondary infertility.

 The results of treatment and comparative characteristics are presented in tables 2-5.

During treatment, patients were divided into two groups:
Group I 29 people received hydrogen sulfide balneotherapy and SMT. Patients of this group (prototype) represented the usual contingent with menstrual dysfunction such as hyperpolymenorrhea. II group of 37 people received treatment according to the proposed method, SMT-phoresis EAHA 5% solution I + hydrogen sulfide balneotherapy.

 Clinical observations have shown that the positive results of the use of CMT-phoresis of EACCs appeared after 4-5 introductory procedures, the next menstruation in 6 women who started treatment the day before decreased both in time and in blood loss. More persistent results were noted in those who completed treatment (without significant differences depending on the combination of vacation procedures).

 Clinical results in groups were compared with laboratory and functional examination data (tables 2, 3, 4). As can be seen from table 2, under the influence of the proposed complex, the state of red blood significantly improved due to an increase in the color index. In addition, one can see how the voltage in the system of non-specific immunological reactivity decreased. This is evidenced not only by a physiological decrease in total lymphocytes, but also by the nature of adaptive reactions. If we take into account that patients of group II treated with the proposed method left a more complex contingent with hyperpolymenorrhea in 86.4% of them, then changes in the peripheral blood picture clearly confirm the advantages of this method. This is also confirmed by more positive changes in the protein spectrum of blood serum and blood supply in the pelvic basin.

 The results of treatment in groups with their gradation, as significant improvement, improvement, slight improvement and without changes, are presented in table 5. In the control group with a clear improvement, 16 (55.17%) patients were discharged; in 2, the condition did not change. Under the influence of the proposed treatment complex, significant improvement was noted in 4 cases, improvement in 22, slight improvement in 10 cases, 1 patient was discharged without changes.

 Thus, the proposed method is more efficient, does not require technical costs and can be used in practical health care.

Claims (1)

1 A method of treating inflammation of the appendages in women with hyperpolymenorrhea, including exposure to a physical factor and conducting hydrogen sulfide balneotherapy in the form of vaginal irrigation and general baths, characterized in that the effect is carried out by means of CMT phoresis of a 5% solution of epsilonaminocaproic acid on the projection area of the uterus and appendages into in a straightened mode with a frequency of 100 60 Hz, using I-III and IV type of work, with a total duration of 20 minutes the first five days daily, then alternating with hydrogen sulfide balneotherapy, which is carried out s day with the normal function of the ovaries or two days in a row on his break when initially reduced.

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