RU2142821C1 - Method for treating acute inflammatory diseases of female internal genitalia - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves exposing 7-8% of total circulating blood volume to ultraviolet radiation and subjecting the irradiated blood to centrifugal plasmapheresis with following 1 ml of adenosine triphosphoric acid and single antibiotic dose added to the cell mass. After being incubated, the produced mixture is brought back through dropper to patient blood circulation. Total treatment course is 4-6 sessions long, with 48 h intervals separating the sessions. EFFECT: enhanced effectiveness of treatment; low doses of antibiotics. 2 tbl

Description

 The invention relates to medicine and, in particular, to gynecology.

 Inflammatory diseases of the female genital organs continue to be one of the urgent problems of modern gynecology. According to WHO (1982), the incidence of inflammatory diseases of the female genital organs is 10–13 per 1000 women; among patients, 75% are women under 25 years old, of which 75% are nulliparous. Even after a single episode of inflammation of the fallopian tubes, their occlusion occurs in 13% of cases, and after 3 - in 75%. Untimely and inadequate treatment of acute inflammatory diseases of the genitals leads to a chronic process and is the cause of infertility, ectopic pregnancies, pelvic pain, causing suffering and even disabling women at the age of social activity.

Known drug treatment of acute inflammatory diseases of the internal genital organs in women, including antibacterial, detoxification, desensitizing, restorative therapy (Savelyeva G.M., Antonova L.V. Acute inflammatory diseases of the internal genital organs of women. - M .: Medicine, 1987, pp. 103-119.) However, despite the use of new drugs, the maximum dose of broad-spectrum antibiotics, this method has several disadvantages:
- the use of maximum therapeutic doses of broad-spectrum antibiotics causes immunosuppression, inhibits the nonspecific protection of the body, has a toxic effect on the patient's body,
- with intramuscular and intravenous administration of antibiotics, an insufficient concentration of drugs is created in the focus of inflammation due to the existence of an inflammatory shaft and their destruction in the general bloodstream by deactivating systems of the macroorganism,
- This method is not effective enough, despite the large economic costs.

The closest way to treat acute inflammatory diseases of the internal genital organs of women is a complex medication using UV irradiation of blood (Chalenko V.V., Zhilkina S.V., Chalenko I.O., Zaitseva N.N. Photomodification of autologous blood in complex treatment inflammatory purulent-septic diseases of the female genital organs. - Akush. and gyn., 1990, N 4, p. 67.)
Despite the achieved bactericidal effect, the method has disadvantages: - high doses of antibiotics cause the development of dysbiosis and suppression of immunity.

 The objective of the invention is to increase the effectiveness of treatment of acute inflammatory diseases of the internal genital organs of women and reduce the dose of antibiotics used.

 This goal is achieved in that 7-8% of BCC is subjected to ultraviolet light, then centrifuged plasmapheresis of irradiated blood is carried out with 1 ml of ATP (adenosine triphosphoric acid) and a single dose of antibiotic injected into the cell mass, and after incubation the mixture is returned dropwise to the patient’s bloodstream, while the course of treatment is 4-6 sessions with an interval of 48 hours.

To justify these modes, the following provisions are given:
1. The removed volume of 7-8% of the BCC is larger than the commonly used volumes used when irradiated with ultraviolet light, but it does not cause physical, chemical, biological, cytological and other blood parameters in the patient and is not accompanied by changes in systemic hemodynamics. We use this volume of blood (7-8% of BCC) due to the fact that we use it in the acute inflammatory process and then use it for centrifugal plasmapheresis.

 2. The incubation of blood irradiated with ultraviolet light is due to the fact that blood after irradiation acquires high biological activity due to cells on the membrane of which lipid peroxidation is activated, destruction of thiol compounds and a-tocopherol increases, passive permeability of membranes, activity of membrane receptors increase, in addition , the number and activity of T and B lymphocytes and their phagocytic activity increased, which contributed to a more active absorption of antibacterial drugs to blood spots. The simultaneous implementation of UFOK and PCM with an antibiotic is due to the fact that in the acute inflammatory process, the main role is played by the microbe, and the use of isolated UFOK can cause, due to a sharp increase in microcirculation, a massive release of microbes and their toxins into the bloodstream and lead to a generalization of the process.

 3. ATP at a dose of 1.0 ml added to the blood cell mass increases the saturation of the blood cell mass with an antibiotic and the blood cells containing the antibiotic are less destroyed in the systemic circulation and, under the influence of chemotaxis enhanced by UFOK, migrate to the focus of acute inflammation, carrying out directed antibiotic transport and maintenance its therapeutic concentration in the focus of inflammation with a significant decrease in the daily and course dose.

 4. Fractional plasmapheresis helps to improve tissue respiration and increase cellular metabolism, removes toxic products from the blood, has an immunostimulating effect, which increases the general reactivity of the body.

 5. The interval between the procedures is chosen on the basis that the half-life of antibiotics from the inflammatory focus is 48 hours, and the number of sessions 4-6 is optimal for stopping the acute inflammatory process.

The essence of the method is as follows:
1. The patient is subjected to exfusion of 7-8% of the volume of circulating blood. In this case, the patient’s blood flows through a disposable system and a flowing quartz cuvette into a sterile vial with 5-10 thousand units. heparin per 50 ml of saline. When passing through a cuvette, the blood is irradiated with a DRB-8 type mercury lamp from a distance of 30 mm. The wavelength is 254 nm, the irradiation power is 20 W / m, and the total exfusion time is 15 minutes. During this time, 400-500 ml of blood enters the vial. After that, the blood irradiated with ultraviolet light is centrifuged at 2000 rpm (700 g) for 15 minutes, followed by removal of the plasma (centrifugal plasmapheresis). 1.0 ml of ATP and a single dose of a broad-spectrum antibiotic allowed for intravenous administration are added to the remaining cellular mass of blood. Incubation of the resulting mixture is carried out at a temperature of 18-24 ^o C for 20 minutes with periodic gentle stirring of the mixture. After incubation, the mixture is returned into the bloodstream of the patient intravenously.

 The course of treatment is usually 4-6 sessions. The interval between the procedures is two days. However, other methods of antibiotic therapy are not used.

 (The scheme of the treatment method and the time spent in this case (Table 1) are given at the end of the description).

 We have treated 25 patients with acute inflammatory diseases, the treatment results are shown in table. 2.

 Clinical example.

Patient S. was admitted with complaints of intense pain in the lower abdomen, radiating to the rectum, fever up to 39 ^o , chills, weakness, malaise for 2 days.

Upon receipt discovered - o.an. blood: COE-52 mm / h, L-7.7 • 10 ⁹ , Hb-9.0 g / l, er-4.0 • 10 ¹² p-17, s-56, l-17, m-10.

Ultrasound of the uterus: signs of metroendometritis, cyst of the left ovary of inflammatory genesis. A gynecological examination showed sharp pain on the part of the uterus and appendages; a round, painful formation limited in mobility was palpated on the left;
smear on the flora: L 50-60 in n / a, large cocci;
tank. sowing on flora from c / c: staphylococcus.

The treatment was carried out: the patient underwent exfusion of 7-8% of the circulating blood volume. In this case, the patient’s blood passed through a disposable system and a flowing quartz cuvette into a sterile vial with 5 thousand units. heparin per 50 ml of saline. When passing through the cuvette, the blood was irradiated with a DRB-8 type mercury lamp from a distance of 30 mm. The wavelength was 254 nm, the irradiation power was 20 W / m, and the total exfusion time was 15 min. During this time, 400 ml of blood entered the vial. After that, the blood irradiated with ultraviolet light was centrifuged at 2000 rpm (700 g) for 15 min, followed by removal of the plasma (centrifugal plasmapheresis). 1.0 ml of ATP and a single dose of the antibiotic ampicillin 1.0 and gentamicin 80 mg were added to the remaining cell mass of blood. Incubation of the resulting mixture was carried out at a temperature of 18-24 ^o C for 20 minutes with periodic gentle stirring of the mixture. After incubation, the mixture was returned to the patient’s blood stream intravenously.

 The course of treatment usually amounted to 5 sessions. The interval between procedures is two days. However, other methods of antibiotic therapy were not carried out.

 During treatment, the condition improved significantly: the temperature returned to normal on the 3rd day, the pains in the lower abdomen stopped, weakness, and malaise went away. According to laboratory data, there is a decrease in ESR to 16 mm / h, stab shift to the left to 2, leukocytosis to 5.8.

 Ultrasound recorded a positive trend in the form of relief of inflammatory phenomena: a decrease in the size of the uterus and ovaries, regression of the cyst of the left ovary.

 A vaginal examination noted the absence of pain from the uterus and ovaries and the normal size of the uterus and appendages. When observing the patient for 1 year, there was no exacerbation of the inflammatory process.

The positive effect of the proposed method:
1. Reinfusion of autogenous blood cell mass saturated with an antibiotic in the presence of ATP, after preliminary irradiation of blood with ultraviolet light, can significantly reduce the sensitizing and immunosuppressive effects of the antibiotic on the patient's body, and increase the body's immune resistance.

 2. This method of administering an antibiotic against the background of UFOK allows reducing the dose of the antibiotic by 5-8 times, creating favorable conditions for the penetration of the antibiotic into the focus of inflammation (see table 2).

 3. Reducing the dose of the administered antibiotic reduces the toxic effect of the drug on the patient's body and reduces the number of fungal complications (see table. 2).

 4. The combined use of UFOK and RAKM with an antibiotic significantly reduces the number of complications of acute inflammatory diseases of the internal genital organs in the form of a generalization of the process, transition to a chronic form, menstrual and reproductive disorders.

Claims (1)

 A method of conservative treatment of acute inflammatory diseases of the female genital organs, including antibiotic therapy and ultraviolet irradiation of the blood, characterized in that 7-8% of BCC is subjected to ultraviolet light, followed by centrifuged plasmapheresis of irradiated blood with 1 ml of ATP (adenosine triphosphoric in the cell mass) acid) and a single dose of an antibiotic and after incubation return the resulting mixture dropwise to the patient’s bloodstream, while the course of treatment is 4-6 sessions with at 48 hours

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