RU2275918C1 - Method for treating chronic salpingo-oophoritis - Google Patents

Abstract

FIELD: medicine, gynecology.

SUBSTANCE: one should carry out galvanization during 15 min due to applying electrodes along abdominal-sacral technique. Just before galvanization one should introduce 15 ml 2%-chitosan ascorbate gel containing metronidasol at the dosage of 2 mg/ml gel, intravaginally at 36-38° C. Procedures should be carried out once daily, therapy course lasts for about 7-8 d. The innovation suggested provides total curative effect of antibacterial remedies and galvanization at decreased dosage of metronidasol and, thus, enables to obtain stable remission of salpingo-oophoritis.

EFFECT: higher efficiency of therapy.

1 ex, 1 tbl

Description

The invention relates to medicine, namely to gynecology, and can be used to treat chronic salpingo-oophoritis.

The urgency of the problem is determined by the high frequency, the tendency to generalization and chronicity of the inflammatory processes of the female genital organs, a long, recurrent course; the development of the most serious pathophysiological and pathomorphological changes in the affected tissues. The formation of an adhesion process in the pelvis significantly worsens the quality of life of a woman: it is the cause of infertility, miscarriage and ectopic pregnancy, sexual, menstrual function is disturbed. Adhesive process plays a leading role in the pathogenesis of chronic pelvic pain, which often lead to the development of neurotic conditions. The immune, nervous, endocrine, reproductive, digestive, urinary systems of the body are involved in the pathological process. The working capacity of women has been reduced, often conflict situations arise in the family [1, 2, 3].

There are various methods of treating chronic salpingo-oophoritis, which include the appointment of antibacterial, anti-inflammatory, analgesic drugs, physiotherapeutic and balneological effects, and spa treatment. Physical methods of exposure are widely used to reduce the drug load on the woman’s body and improve the effectiveness of treatment: electrophoresis of the uterine appendages with Esobel mud extract with simultaneous exposure through the vagina to an alternating magnetic field; electrophoresis of uterine appendages with 1% silt sulfide mud; low-frequency magnetotherapy and endovascular laser irradiation of blood; hydrogen sulfide therapy in the form of vaginal irrigation and common baths by exposing biologically active points to electromagnetic radiation; EHF-therapy for paired reflexogenic points of the uterus and ovaries with the connection of iodine-bromine balneotherapy every other day in the form of vaginal irrigation and shared baths; hyperbaric oxygenation; laser therapy and vaginal hypothermia [4, 5, 6, 7, 8, 9].

However, the traditionally used methods of treatment of chronic salpingo-oophoritis are not effective enough, since they do not always allow achieving full rehabilitation of patients, preventing relapses, and achieving stable remission of the disease. Allergic reactions can develop on the mud components; most methods are difficult to perform and inaccessible for widespread use, taking into account socio-economic aspects. All this dictates the need to search for new effective treatment methods that can achieve a stable remission, prevent the development of relapses, reduce the frequency of their occurrence, prevent the development and reduce the adhesion process in the small pelvis, which significantly worsens the quality of life of a woman.

Closest to the claimed is a method of treatment, which consists in conducting electrophoresis with a 3% solution of potassium iodide according to the abdominal-sacral technique (cathode on the pubic region, anode on the sacral region), the current strength of up to 10 mA, which is selected individually, is increased to the sensation of slight tingling , exposure time 20 min, the number of procedures 10-12 [11]. The disadvantages of this method are

- the duration of the sessions;

- insufficient treatment effectiveness;

- high recurrence rate of the disease;

- insignificant ability to reduce the adhesion process in the pelvis.

The problem solved by the invention, increasing the effectiveness of treatment, which allows achieving stable remission, reducing the adhesion process in the pelvis, relieving chronic pain, improving the quality of life of a woman, reducing the time of treatment and rehabilitation measures.

The objective is achieved due to the fact that as a medicinal substance use 2% gel of chitosan ascorbate containing metronidazole in a dose of 2 mg / ml, in a volume of 15 ml, at a temperature of 36-38 ° C, 1 time per day immediately before galvanization, course 7 -8 days, exposure time 15 minutes.

The method is as follows. Before the galvanization, in the treatment room in the Trendelenburg position, on the gynecological chair, the external genital organs are sanitized with an antiseptic solution, a Cuzco mirror is inserted into the vagina, the mucous membrane of the vagina is treated with an aqueous solution of furatsilin 1: 5000, a 2% cotton wool moistened with a clamp is moistened with a clamp on a clamp chitosan ascorbate with metronidazole at a temperature of 36-38 ° C in an amount of 15 ml once a day. For galvanization use the apparatus ("Potok-1"), the electrodes are applied according to the generally accepted abdominal-sacral technique (cathode on the pubic region, anode on the sacral region). At the same time, the current strength is selected individually from 5-10 mA, which is increased to a sensation of slight tingling. The procedure is carried out for 15 minutes for 7-8 days.

A polysaccharide biopolymer of a 2% finely dispersed, water-insoluble chitosan ascorbate gel (a medical product of deacetylation of chitin of king crab shell, deacetylation of 75-99%, molecular weight of 100-700 kDa, pH 5.5-7.4) is used as the basis for the drug composition.

The drug is characterized by high biocompatibility, low toxicity, biodegradability, antimicrobial, antitoxic and mucoadhesive properties, odorless, slightly opalescent, capable of sorbing antigenic material by electrostatic, chelating or affinity mechanism. The mechanism of action of the chitosan polymer is based on the fact that, provided that a natural barrier is created between the inflammatory focus and chitosan, a mucoadhesive membrane is formed, which in an acidic environment (vagina), due to the positive charge of the biopolymer, provides interaction with the anionic components of epithelial cells. As a result, asymmetric contraction of the cytoskeleton of the cells occurs, the apical fragments of the cells diverge and, as a result, tight intercellular contacts open, paracellular transport increases, and the phenomenon of perfusion of the liquid and cellular parts towards the charged polymer arises. Penetrating into the tissue, chitosan absorbs inflammatory products (BAS) that inhibit phagocytosis and cell migration, and creates favorable conditions for attracting peritoneal macrophages, which interrupt the pathological process, as they exhibit antagonistic properties with respect to fibroblasts and their products, hindering the organization and formation of extensive adhesions. Due to the adhesive properties of chitosan, adhesion of fibroblasts occurs and hyperproduction of fibrous tissue is suppressed.

The main purpose of the application is the treatment of chronic salpingo-oophoritis by removing antigenic material that causes inflammation, normalizing the vaginal microflora to prevent the ascending path of infection, preventing and reducing the adhesion process in the small pelvis by applying the gel through the vagina, ensuring immediate anatomical proximity to the adhesive process, stopping chronic pain syndrome.

10 patients aged 20-40 years were examined and treated, the average age was 29.7 years. In all patients, on the basis of complaints, anamnesis of the disease, clinical picture, vaginal status, laboratory and instrumental and additional research methods, chronic salpingo-oophoritis with a pronounced adhesion process was diagnosed. The treatment method we proposed was prescribed in the subacute stage and stage of remission of chronic salpingoophoritis: galvanization with the preliminary administration of a vaginally 2% chitosan ascorbate gel containing metronidazole at a dose of 2 mg / ml on a tampon.

Before treatment, the patient complained of the following: a constant pain in the pelvis, manifested by pulling pains in the lower abdomen, with radiation to the lower back, sacrum; menstrual dysfunction: painful, heavy menstruation, menstrual irregularities; dysuric phenomena; constipation increased secretions from the genital tract. Anamnestically: the number of exacerbations for the period from 2002-2004 was on average 4 times in each patient. In a vaginal examination, all women to varying degrees determined pain on palpation of the lower abdomen, pain on palpation of the appendages, limitation of the mobility of the appendages, difficulty in palpating due to a pronounced adhesion process, severe structure of the appendages, pain on traction of the cervix, restriction of uterine mobility, uterine position in the small pelvis retroflexio, leucorrhoea. All women underwent a smear sampling to study the microflora composition, in which an increased number of leukocytes, epithelial cells, and the presence of gram-positive cocci were found. Bacteriological examination revealed the growth of normal microflora in 7 women, Gardnerella vaginalis in 1 woman, Staphilococcus aureus in 2 women, analyzed a clinical blood test, revealed moderate leukocytosis, a slight increase in the erythrocyte sedimentation rate (ESR). One of the additional criteria for the effectiveness of treatment was an indicator of erythrocyte deformability (PDE), which makes it possible to assess the state of erythrocyte membrane structures and the severity of endogenous intoxication in infectious and inflammatory processes. The erythrocyte deformability index was evaluated by the generally accepted method according to Dormandi in the modification of Yu.I. Grinshtein [10]. In all women, PDE was higher than normal. An ultrasound study determined the presence of signs of oophoritis (an increase in ovarian size, the presence of fluid inclusions in the stroma of the ovary, indirect signs of an adhesive process in the pelvis).

The proposed method treated 10 women who made up the first group, who were injected vaginally with 2% chitosan ascorbate gel with metronidazole at a dose of 2 mg / ml on a tampon in an amount of 7 mg per ml for 7-8 days after preliminary sanitation of the vagina with an aqueous solution of furacilin 15 ml once a day, the duration of the procedure is 15 minutes.

The second group consisted of 10 women who underwent electrophoresis in a subacute and remission stage with a 3% potassium iodide solution and electrodes were applied according to the abdominal-sacral method, current strength up to 10 mA, exposure time 20 min, number of procedures 10-12.

The effectiveness of the study results was evaluated by the following criteria: patient complaints, gynecological examination, bacteriological examination of the vaginal flora (bacterioscopic and cultural diagnostics), clinical analysis of blood and PDE.

Table 1
The characteristic of clinical signs of chronic salpingoophoritis in the dynamics of treatment. Signs of the disease Gel galvanization ascorbate-chitosan-metronidazole Electrophoresis with 3% potassium iodide solution Days of treatment 3 5 7 10 3 5 7 10 Pain syndrome + - - - +++ ++ + - Tender palpation tenderness ++ + ^- - +++ ++ + + - Sore palpation of the appendages +++ + - - +++ ++ + ^- Appendage limitation ++ + + - +++ ++ + + - The heavy structure of the appendages ++ + + - - +++ ++ + + - Soreness in cervical traction ++ + - - ++ ++ + - Restriction of uterine mobility +++ ++ + - + - +++ ++ ++ + The position of the uterus in the pelvis (retroflexio) ++ ++ + + - +++ ++ + + The presence of leucorrhoea ++ + - - ++ ++ + + - PDE 12% 7% 5% four% 12% 10% 9-8% 6% An increase in ovarian size according to ultrasound ++ + - - ++ ++ + - Note: (+++) the sign is expressed significantly, (++) the sign is expressed satisfactorily, (+) the sign is unclear, (-) the sign is absent.

During treatment in the first group of patients, complaints of pain in the lower abdomen disappeared by the end of the third day, on day 5, 90% of women had no pain in the lower abdomen and lumbosacral region. By the end of 5 days, the number of vaginal discharge was significantly reduced in 70% of women, on the seventh day there was no leucorrhea in patients. In a bimanual study: on day 5, minor pain remained during palpation of the appendages in 20% of women, on day 7, the sensitivity of the appendages during palpation was absent; limited mobility of appendages by the end of 7 days remained in 10% of women; restriction of uterine motility on the 5th day remained in 30%, and on the 7th day in 10% of women; position of the uterus in the pelvis anteflexio on the 7th day in 80% of women. The erythrocyte deformability index before treatment was 14%, and on the 7th day of treatment all women were within normal limits (0-6%), which indicates a decrease in the degree of the inflammatory process and the effectiveness of the treatment. In 2 women, during bacteriological examination of the vaginal discharge before treatment, Staphilococcus aureus was found, in 1 woman Gardnerella vaginalis, after treatment during the study, these pathogens were not found, which indicates the antimicrobial effect of chitosan ascorbate. All women had normalized vaginal microflora, increased lactoflora, which prevents the ascending path of infection of the uterine appendages.

All women after treatment with the proposed method without delay began menstruation, moderate, painless, which may also indicate the effectiveness of the treatment of chronic salpingoophoritis.

During treatment in the second group of women, pain in the pelvis was not stopped on the 7th day of treatment in 30% of women, on the 10th day in 10%. Sore palpation of the appendages during bimanual examination remained on the 5th day in 50%, and on the 7th day in 30% of women. The restriction of the mobility of the appendages was detected on the 7th day in 40%, by 10 in 20% of women. The restriction of uterine motility persisted on day 7 in 40%, on day 10 in 20% of women. The uterus in the retroflexio position persisted for 10 days in 30% of women. PDE reached the norm on the 10th day of treatment, which indicates a longer course of the infectious and inflammatory process compared to the first group. In the dynamics of observations (within 2 months) in 60% of women after treatment, menstrual dysfunction continued: menstruation was painful, heavy and started with a delay.

The number of procedures depends on the presence of signs of recovery and the achievement of a lasting therapeutic effect: patient complaints; gynecological examination; Ultrasound research; normalization of peripheral blood counts; erythrocyte deformability index normalization; assessment of the degree of vaginal frequency, the duration of treatment averaged 7-8 days.

Clinical example. Patient D., 40 years old, applied to the antenatal clinic at the place of residence on 10/20/04. with complaints of constant pain in the lower abdomen, aggravated by physical exertion, with radiation to the lumbar region, sacrum; violation of menstrual function as algodismenorrhea, hypermenorrhagia; pain discomfort during intercourse, infertility for 4 years. From the anamnesis it is known that he suffers from chronic salpingoophoritis for 9 years, notes stable exacerbations 2 times a year. There were no gynecological operations. In 1978, the patient underwent a laparotomy for acute appendicitis, diffuse peritonitis. A gynecological examination revealed: hyperemia of the mucous membrane of the vagina and cervix, moderate pain during palpation of the uterus, palpation of the uterus and uterus, severe structure of the appendages, uterus in the retroflexio position, shortening of the vaginal arches, and leucorrhoea. When examining the vaginal discharge by the bacterioscopic method (Gram stain), the following were found: epithelial cells completely, white blood cells 20-25 in n / a. In a cultural study: the growth of normal microflora. In the clinical analysis of blood ESR - 15 mm / h, PDE - 14%. Ultrasound examination of the genitals: the uterus in the retroflexio position, an increase in the size of the ovaries, a small amount of free fluid in the adjacent space. He was diagnosed with chronic salpingo-oophoritis in the subacute stage, for which galvanization was performed with electrodes applied according to the abdominal-sacral method, with a current of 10 mA for 15 minutes, after preliminary sanitation of the external genital organs and vagina with a solution of furacilin 1: 5000 was introduced vaginally on a sterile swab 2% gel of chitosan ascorbate containing metronidazole in an amount of 2 mg / ml at a temperature of 36-38 ° C 1 time per day immediately before galvanization. After our treatment, the woman did not complain, the pain was stopped on the 5th day, painless palpation of the appendages was absent on the 5th day, a significant increase in the mobility of the uterine appendages was on the 7th day of treatment, on the 8th day the uterus was determined in the anteflexio position, the vaginal vaults are free, there is no whitening on the 5th day of treatment. There is a normalization of the smear on the microflora: epithelial cells 2-3 in n / a., Single white blood cells, Gram (+) sticks abundantly. PDE in dynamics amounted to 5% on the 5th day - 7%, on the 8th day - 4%. In a clinical blood test, ESR is 7 mm / h. When examining the patient in a month: there were no pains in the lower abdomen, menstruation without delay, painless, no pain during intercourse. During vaginal examination, residual adhesions in the small pelvis were established. A repeated course of treatment after a month is recommended.

Thus, the proposed method for the treatment of chronic salpingoophoritis allows to reduce the treatment time by 1.5 times on average (7-8 days versus 11-12 in the control group), reduce the duration of the procedure (15 minutes versus 20 minutes in the control group), prevent the formation of reduce the adhesive process in the small pelvis, stop the chronic pelvic pain syndrome, normalize the vaginal microflora, prevent the ascending pathway of infection of the uterine appendages, restore menstrual dysfunction, significantly improve the quality of the quality of a woman’s life, to provide a lasting therapeutic effect.

Information sources

1. V.P. Smetnik, L.G. Tumilovich. Non-operative gynecology. Moscow, 2002, p. 382-391.

2. V.V. Yaglov. Inflammatory diseases of the pelvic organs. G. Gynecology, 2001, No. 3, pp. 93-97.

3. V.Kh. Khusainova, T.A. Fedorova. Diagnosis, treatment and prevention of adhesions in the pelvis in women suffering from tubal-peritoneal form of infertility. G. Gynecology, 2002, No. 2, pp. 58-62.

4. RF patent No. 2196562, A 61 H 33/02, A 61 N 5/02, A 61 H 39/00, 01.20.2003.

5. RF patent No. 2195249, A 61 H 39/00, A 61 N 5/02, A 61 H 33/00, 12/27/2002.

6. RF patent No. 2215556, A 61 N 1/31, A 61 N 2/04, 10.11.2003.

7. Bogdashkin N., Korobov A., Krasnov V., Palamarchuk O. Laser therapy in the complex physiotherapy of patients with a chronic salpingo-oophorite and a pain syndrome. // Proceedings of the 8th International Congress of the European Medical Laser Association (EMLA) and the 1st Russian Congress of the Medical Laser Association (RMLA), Moscow, May 23-26, 2001. - P.122-123, - Russian .; English - ISBN 5-93139-087-1. - RU.

8. S.A. Nevostruev. Morphofunctional state of the uterus in chronic inflammation and complex treatment using mud extract. Abstract. Ph.D. T-2004, p.2.

9. L.A. Agarkova. Comparative evaluation of the treatment of inflammatory diseases of the uterus with the use of various factors of physical impact. Abstract. Ph.D. T-2000, p.1-15.

10. Yu.M. Grinshtein, I.A. Kalinina, P.V. Vitman. Red blood cell deformability in patients with acute and chronic renal failure // Therapist. Arch. - 1986, - No. 12, p. 91-93.

11. S.I. Fofanov. J. Akush-in and gynecology. 1977, No. 4, pp. 23-26.

Claims (1)

A method of treating chronic salpingo-oophoritis, including preliminary sanitation of the vagina with an antiseptic solution with the introduction of drugs into the vagina before electrotherapy, characterized in that galvanization is used as electrotherapy for 15 minutes, while the electrodes are applied according to the sacroiliac technique, and as a medicine, immediately before galvanization, 15 ml of 2% chitosan ascorbate gel are injected at a temperature of 36-38 ° C, containing metronidazole at a dose of 2 mg in 1 ml of gel, the procedures are carried out 1 time per day, the course of treatment is 7-8 days.