RU2145891C1 - Method for carrying out complex therapy of infectious toxic chronic adnexitis of nonspecific etiology - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering antibiotics in vaginal submucosa at a dose of 1/4 of daily dose. Tampon with SUMS-1 is introduced into the vagina. Trypsin or chemotrypsin suppository is introduced into the rectum. Stimulation with sinusoid modulated currents is applied. Prodigiosin therapy is given. Immune correction therapy with t-activin is administered. Vaginal microflora is restored with lactobacterin or narine administration. Adaptogenic drugs are administered after dismissing the patient from hospital and vitamin therapy being applied. EFFECT: enhanced effectiveness of treatment course. 3 cl, 6 dwg

Description

 In the treatment of chronic nonspecific inflammatory diseases of the uterine appendages, many methods of treatment are currently proposed. It should be noted that in recent years there has been a tendency toward polypharmacy, as a consequence, the inclusion in the complex therapy of more and more new drugs (7, 13, 16). Apply antibacterial, desensitizing, immunocorrecting, symptomatic, vitamin therapy. According to the indications of detoxification (4, 5, 7, 8, 9, 22).

 Currently, it is known that the lymphatic system is involved in all pathological processes, regardless of their etilogy and pathogenesis, because through the lymphatic system, the decay products of cells, proteins, large molecular substances, bacteria and their toxins from the focus of inflammation are resorbed (1, 2, 14, 17). Disorders in the lymphatic system, the inadequacy of its functions affect the development and outcome of the disease. Correction of disorders, as well as optimization of its inadequate functions, is an important condition for therapy. The saturation of the lymphatic system with drugs allows you to intervene in the transport, metabolic, immune, barrier and other functions of the lymphatic system (1, 2, 3, 11, 12).

 Keith L.G. at all. (1989) described the relationship of the cervical lymphatic system with the overlying sections of the lymphatic tract.

 It is known that in patients with chronic inflammation, macrophages are not able to remove molecules and cells foreign to the body from the circulation, accumulating them intracellularly, not “digesting” them and “not representing” the antigen molecules to lymphocytes, thereby not triggering a specific immune response. Inactive macrophages are not capable of causing the death of captured microbes; the latter inside the macrophage can not only persist, but even multiply. Antibiotics do not act on microbes located intracellularly, and macrophages loaded with viable and propagating microorganisms can act as "carriers" of the pathogen in the body (18).

 Under the influence of microbes or their products (lipopolysaccharides), cells are transformed into fully activated cells with the maximum mobilized cytopathogenic potential (17, 20). Moreover, macrophages stimulated by LPS of E. Coli produce more β-endorphin than intact cells. Interleukin-1 produced in this case leads to an increase in corticosterone levels after a maximum of 2 hours, and ACTH after 30-60 minutes. When studying the mechanisms of regulation of the synthesis of interleukin-1, PGE-2, the dependence of these processes on the functional state of macrophages was revealed (6).

 Classical exogenous pyrogens, such as pyrogenal and prodigiosan, are also classical immunomodulators - stimulators of the mononuclear phagocyte system. Synthesized Z.V. Ermolieva and G.E. Braude prodigiosan activates the pituitary-adrenal system, enhances the activity of the reticuloendothelial system, phagocytosis, and increases resistance to viral infection by stimulating the formation of endogenous interferon (15). These substances that increase body temperature are lipopolysaccharide complexes derived from bacteria. Under the influence of prodigiosan, macrophages are activated: they increase in size, the rate of glucose oxidation and the activation of lysosomal enzymes increase. Activated macrophage products, such as PGE, interferons, collagenases and other neutral proteinases, lysosomal hydrolases, have antifibrotic effects. With adequate stimulation, these antifibrotic factors sharply inhibit fibrosis (19). Macrophages incubated in the presence of LPS acquire pronounced cytotoxicity against syngeneic or allogeneic tumor cells, but not cells with normal growth parameters (10).

 As a prototype, we propose a method for the treatment of chronic adnexitis of an infectious-toxic variant, described by V. P. Smetnik et al. (1995). The method consists in the introduction of antibiotics, detoxification, desensitizing, physiotherapy and symptomatic therapy.

 We propose a comprehensive method for the treatment of non-specific chronic inflammatory diseases of the uterine appendages, an infectious-toxic variant, and a non-specific etiology.

 The technical result of the proposed method is to increase the effectiveness of treatment, prevention of relapse.

The proposed method is as follows:
1) For 5-7 days, antibiotics are administered into the submucosa of the lateral vault fornix, after which a 2 g swab with SUMS-1 is inserted into the vagina, and a candle with trypsin or chemotrypsin is inserted into the rectum and treatment is carried out after 10-15 minutes sinusoidal modulated currents.

 2) After this, sanitation of chronic foci of infection of the nose and pharynx is carried out.

3) After this, prodigiozan is prescribed with the selection of an individual therapeutic dose and, when the body temperature rises to 37.8 ^o C, antibiotics (kanamycin, ampicillin, gentamicin) are introduced into the submucosa of the lateral vaginal fornix in a 1/4 daily dose, and candles are inserted into the rectum with trypsin or chemotrypsin and after 10-15 minutes carry out physiotherapy with sinusoidal modulated currents, immunocorrective therapy with T-activin is carried out for 5 days, taking into account the sensitivity of blood lymphocytes to it, then restore microflora agonist lactobacterin or Narin.

 4) After discharge from the hospital for 6 months, adaptogens (eleutherococcus, tincture of leuzea or golden root) are prescribed, cyclic vitamin therapy, and restoration of the menstrual cycle according to indications are performed.

 In the presence of anaerobic infection, intraorgan electrophoresis with metrogyl is performed within 3 days.

 Under our supervision for 5 years there were two groups of patients with chronic nonspecific inflammatory diseases of the uterine appendages, an infectious-toxic variant. Their average age was 27.9 ± 1.14 years.

 The first group of 30 people was treated according to the generally accepted method, the second - 50 people - according to the proposed method of treatment.

 The treatment results were evaluated in three categories: recovery (disappearance of general and local symptoms of inflammation, biochemical signs of inflammation activity, normalization of immunological reactivity and hormone levels, normalization of reproductive function), improvement (improvement of well-being, cessation of pain and secretions, reduction of infiltrative changes in the uterine appendages ), lack of effect (stabilization or increase of clinical signs of inflammation).

 Long-term results of treatment were taken into account in three categories: the frequency of relapses, the duration of remission for 5 years of observation, and the restoration of reproductive function.

 In patients with chronic salpingitis, the infectious-toxic variant in the first group immediately after treatment was observed to have a partial effect in 66.67% of cases; there was no effect from the therapy in 33.33% of patients. All patients had a relapse of the disease after 3-6 months. Indicators of the immune (table. 1) and endocrine status (table. 2), circadian rhythm of thymosin-alpha1 (table. 3) in these patients did not recover.

 In the second group after treatment for the entire observation period, there was no relapse of the disease, reproductive function (Table 4), immunity indicators (Table 5) and the circadian rhythm of thymosin-alpha1 (Table 6) were restored one year after treatment.

Abbreviations Used
Tables 1, 5.

 P - early E-rosette-forming cells (E-ROCK) - helper inducers.

 P / M - helpers / inducers morula ("sockets", surrounded by more than 10 sheep red blood cells.

 B - restored E-ROCK - suppressors / killers.

 V / M - suppressors / killers morula.

 P: C is the ratio of helpers / inductors to suppressors / killers.

 C - stable E-ROCK.

 T - total E-ROCK (total number of differentiated T-lymphocytes).

 T / M - total E-ROCK morula.

 K - complex E-ROCK (poorly differentiated T-lymphocytes).

 K / M - complex E-ROCK morula.

 PFT - an indicator of the function of the thymus, reflecting the processes of differentiation of T-lymphocytes.

 IIM - migration inhibition index.

 IM - migration index.

 PEF is an indicator of effector functions.

 Tables 2, 4.

 ACTH is an adrenocorticotropic hormone.

 FSH is a follicle-stimulating hormone.

 LH is luteotropic hormone.

 LH / FSH is the ratio of the amount of luteotropic hormone to the amount of follicle-stimulating hormone.

 ASG / E is the ratio of the amount of progesterone to the amount of estriol.

 PSG is progesterone.

 E - estriol.

 Example 1. Patient Sh., 18 years old, N case history 7240, was undergoing treatment and examination in the III department of the gynecological hospital N 2 of Novosibirsk with a diagnosis of exacerbation of chronic bilateral salpingo-oophoritis, infectious-toxic variant, non-specific etiology, cystic degeneration of the left ovary. From the anamnesis it is known that since childhood he suffers from frequent colds, tonsillitis, and often takes antibiotics. Monthly from 14 years, irregular, after 30 - 45 days, profuse painful. Inflammation of the appendages of the uterus suffers from 16 years. She was treated twice in the hospital, but after the transferred flu or sore throat, pains again appear in the lower abdomen, pains appear, and body temperature rises. It takes antibiotics on its own.

During a clinical examination, a general blood test revealed leukocytosis with a shift of the formula to the left, lymphopenia, monocytopenia, accelerated ESR (Hb 128, leukocytes-11.4 • 10 ⁹ / l, stab neutrophils - 8%, segmented - 65%, lymphocytes - 21 %, monocytes - 5%, ESR - 24 mm / hour).

 Urinalysis without pathological changes.

 Positive C-reactive protein 3 PIECES. Bacterioscopy of a vaginal smear showed III degree of purity.

 In the study of T-cell immunity, immunodeficiency was revealed, which was expressed in an increase in the number of "active" lymphocytes, helpers / inductors with high affinity binding, a decrease in the index of helpers / inducers for suppressors / killers and a decrease in the total number of T-lymphocytes, an indicator of the function of the thymus and effector T-lymphocyte functions (P - 22%, P / M - 11%, P: B - 0.72, T - 35%, K - 30%, PFT - 0.61, PEF - 0.74).

 The greatest sensitivity of lymphocytes to tactivin for succinate dehydrogenase was detected in the morning.

 In a bimanual study, the uterus was not enlarged, limited in mobility, the appendages on both sides were pasty, enlarged, painful, a cystic ovary in the adhesions was determined on the left.

 The patient was treated: penicillin 500 thousand units after 4 hours intramuscularly for 5 days, intraorgan electrophoresis with metrogyl for 3 days, for 5 days 0.5 g of kanamycin was injected into the submucous membrane of the lateral vaginal vault, a swab with SUMS-1 was injected into the vagina in an amount of 2 g (for 16 hours), a candle with trypsin was introduced into the rectum, and after 10-15 minutes physiotherapy was carried out with sinusoidal modulated currents.

 In the hospital, the patient was examined by an otolaryngologist, a diagnosis was made - a curvature of the nasal septum, chronic decompensated tonsillitis, pharyngomycosis. At the same time, the patient was treated for pharyngomycosis: gargling with 1% vinegar solution, lubricating with Lugol's solution, chewing levorin of 500 thousand units after 6 hours, decamine caramel, ultraviolet throat.

 Significant improvement was noted on the 3rd day of treatment: body temperature returned to normal, pains in the lower abdomen decreased.

On the fifth day, blood counts improved: the number of leukocytes was 6.8 • 10 ⁹ / l, stab neutrophils - 4%, segmented - 69%, lymphocytes - 20%, monocytes - 7%, ESR - 20 mm / hour, C- reactive protein - 1 unit.

 12 days after the start of treatment, there were no complaints, blood counts returned to normal, gynecological examination determined a uterus of normal size, limited in mobility, appendages in adhesions, sensitive to palpation, immunological parameters, hormonal status did not normalize. After discharge from the hospital, the woman underwent a submucosal resection of the nasal septum, then tonsillectonia.

Then the woman was re-hospitalized and prescribed prodigiosan, the therapeutic dose was 1.25 ml. Against the background of an increase in body temperature to 38 ^o C, gentamicin was injected into the submucosal of the lateral vaginal fornix, then suppositories with trypsin and physiotherapy were carried out in 10-15 minutes with sinusoidal modulated currents, immunomodulatory therapy with tactivin at 08.00 hours, then the Narine vaginal microbiocenosis was restored.

 During the treatment, the woman noted a significant improvement. After treatment with a bimanual examination, the adhesion process in the appendages was not expressed, the left ovary remained cystically altered.

 After discharge for 6 months. the woman took eleutherococcus, cyclic vitamin therapy. In the study of blood hormones, an increase in prolactin levels and a decrease in estriol was revealed, and therefore parlodel was prescribed for 6 months.

 After 6 months after treatment, menstrual function was restored, the immune status was restored. There were no relapses during the observation period.

Example 2. Patient S., 21 years old, N case history of 1518, was treated in III det. Gynecological Hospital N 2 with a diagnosis of exacerbation of chronic bilateral salpingitis, toxic infectious variant, non-specific etiology. From the anamnesis it is known that since childhood he suffers from frequent tonsillitis. Inflammation of the uterine appendages suffers for 5 years. She was treated in the hospital repeatedly, but after treatment the effect was short-lived. Menses from 13 years, established immediately after 28 days for 4 days, painless, moderate. After hypothermia, pains appeared in the lower abdomen, body temperature increased to 38 ^o C, I started taking Biseptol, ampicillin, analgin on my own, but the condition did not improve. Upon admission to the general blood test, leukocytosis with a shift of the formula to the left, lympho-monocytopenia, accelerated ESR (leukocytosis - 14.3 • 10 ⁹ / L; stab neutrophils - 12%; segmented - 74%; lymphocytes - 10%; monocytes - 3% ; ESR - 34 mm / hour). General urine analysis without pathological changes; C-reactive protein - 3 units; vaginal smear - III tbsp. purity. In a bimanual study, the uterus was not enlarged, the appendages on both sides were pasty, clearly not palpable due to sharp pain. The treatment was carried out: penicillin intramuscularly, kanamycin into the submucosa of the lateral vaginal fornix, a swab with SUMS-1 was introduced into the vagina, a candle with chemotrypsin was introduced into the rectum and physiotherapy was carried out in 10-15 min by sinusoidal modulated currents, along with this, the patient received suprastin, vitamin E ascorbic acid. As a result of the treatment, the patient's condition improved, intoxication symptoms, pains in the lower abdomen disappeared. The patient was examined by an ENT doctor, chronic tonsillitis, decompensated, was diagnosed. The patient underwent tonsillectomy, then prodigiosan treatment, intraorgan electrophoresis with metrogyl, lymphotropic administration of ampicillin, immunocorrective therapy with tactivine taking into account the sensitivity of blood lymphocytes, restoration of vaginal microbiocinosis with lactobacterin, cyclic vitamin therapy, eleutherococcus. After a year, the woman regained her immune and hormonal status, there were no relapses during the observation.

 The proposed method treated 50 women aged 18 to 30 years with inflammatory diseases of the uterus, nonspecific etiology and 30 using the prototype method, the effect of the proposed method was 100%, and the prototype method showed a partial effect in 66.67%, no effect in 33.33%, the disease recurred after 3-6 months, and 33.33% of patients underwent surgical treatment.

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Claims (3)

1. The method of complex therapy for patients with chronic adnexitis, an infectious-toxic variant, nonspecific etiology, including the introduction of antibiotics and conventional therapy, characterized in that within 5 to 7 days they administer kanamycin or ampicillin to the submucous lateral layer of the vagina in 1/4 daily doses, then a 2 g swab with SUMS-1 is introduced into the vagina, a suppository with trypsin or chemotrypsin is inserted into the rectum and after 10 - 15 minutes physiotherapy is carried out with sinusoidal modulated currents, after stopping exacerbations sanitize chronic foci of infection of the nose and pharynx, and then prodigiosan is treated with an individual therapeutic dose; when the body temperature rises to 37.8 ^o C, gentamicin or kanamycin is introduced into the submucous lateral vault fornix in a 1/4 daily dose for 7 days , a candle with trypsin or chemotrypsin is injected into the rectum and physiotherapy is performed with sinusoidal modulated currents, immunocorrective therapy with tactivin is carried out for 5 days, taking into account the sensitivity of blood lymphocytes to it , then restore the vaginal microflora by the introduction of lactobacterin or narine, after discharge from the hospital for 6 months, adaptogens, cyclic vitamin therapy are prescribed.  2. The method according to claim 1, characterized in that within 3 days spend intraorgan electrophoresis metragil.  3. The method according to claim 1, characterized in that the restoration of the menstrual cycle.

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