RU2386440C1 - Method of treating chronic cystitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, particularly urology, and concerns treating chronic cystitis. That is ensured by 10 daily intravenous introductions of ozonised physiologic saline with underlying electrotherapy by mesodiencephalic modulation (MDM). On the first 5 days, ozonised saline is introduced intravenously at ozone concentration 9 mg/l in the volume 400 ml with 200 mg of cocarboxylase and 2 ml of 0.5% thiamine bromide added. On the following 5 days, ozonised saline is introduced as endovesical instillations at ozone concentration 9 mg/l in the volume 100 ml. Prior to the treatment and on the 7th day thereof, the blood is analysed for leukocyte count and ESR, and urine for leukocyte count and bacteriuria level. If decrease of these indicators is observed, the therapeutic course is prolonged by the regimen.

EFFECT: method provides a complex effect of antiinflammatory and antioxidant ozone action on cell metabolism and activation of energy metabolism in MDM tissues and thereby increase of local and general immunity, reduced treatment time without by-effects.

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Description

The invention relates to medicine, namely to urology, to methods of treating chronic cystitis in women and men.

Various methods of treating chronic cystitis are known.

A known method of treating chronic cystitis by antibiotic therapy (O. B. Laurent, L. A. Sinyakova, I. V. Kosova, Farmateka No. 16 (111), 2005, 41-44), based on a comprehensive etiopathogenetic approach with to eliminate the cause of the disease. Antibacterial therapy is carried out up to 7-10 days, the choice of drug is carried out taking into account the selected pathogen and sensitivity to it.

However, despite the wide selection of modern antibiotics and uroantiseptics that can quickly and effectively stop symptoms, this type of method has a number of complicating factors: the emergence of resistant strains of pathogens, allergic reactions in patients receiving many drugs for intercurrent diseases, the development of dysbiosis, and violation of immunoregulatory mechanisms and chronicity of the inflammatory process.

A known method of endovascular treatment of chronic cystitis (Levin E.O. Diss. "Cystitis in women: diagnosis and treatment (Clinical and morphological study). M., 1991, S. 177-180), including the introduction into the patient's body of solutions with the use of antiseptic and anti-inflammatory drugs - collargol, dioxidine, chlorhexidine and others, which, along with antiseptic and anti-inflammatory effects, have a side effect in the form of a toxic effect on the mucous membrane of the bladder. At the same time, changes in subcellular damage are noted: protein destruction, inactivation of SH groups, the formation of free radicals, leading to a change in the structural and functional properties of cell membranes, disruption of microcirculation processes, which can cause a deepening of the hypoxic state and degenerative changes in the organ. Structural and metabolic changes can cause functional failure, exacerbation of a chronic disease and its chronicity.

For the treatment of chronic cystitis, physiotherapeutic methods of exposure are used: ultrasonic treatment, laser therapy, iontophoresis, balneotherapy (ozokerite) (N.F. Gamaleya, M.V. Bogolyubova, BME, M., 1985, v. 12, p. 291-297) . Exposure to physical factors improves peripheral and regional blood circulation, improves tissue trophism, normalizes the neurohumoral reaction and impaired immunity reactions, and has an analgesic and anti-inflammatory effect.

The disadvantage of physiotherapeutic methods is the lack of antibacterial effect. Experimental clinical studies have found that, for example, magnetic and laser radiation cause physico-chemical changes in biological tissues in the form of superficial coagulation necrosis, hemorrhages, edema, dystrophic and necrobiotic changes in tissues. The purpose of physiotherapeutic procedures is limited by a number of contraindications: acute purulent diseases, neoplasms, diseases of the cardiovascular system, tendency to bleeding, etc.

As the closest analogue, a method of treating inflammatory diseases has been adopted (Zmyzgova A.V., Maksimov V.A. Monogr. Clinical aspects of ozone therapy. M., 2003, p. 71-72), including intravenous administration of 50-100 ml autologous blood enriched with ozone by mechanical shaking of blood in a container containing a volume of a gas mixture of oxygen with ozone. The therapeutic zone of ozone is 1–2 mg per 70 kg body weight (Held H.G., Hanno P.M., Wein A.J. London: Stringer Verlag; 1990, p. 125-127).

However, the known method has several significant disadvantages. For the collection and ozonation of blood requires special hardware. Possible mechanical damage to red blood cells on the wall of the dishes. An increase in the concentration of superoxidionion radical and hydroperoxide radical causes an undesirable effect on the formed elements of the blood and stimulates lipid peroxidation (LPO). An increase in lipid peroxidation affects the structural and functional state of the cytoplasmic membranes, leads to a change in the reactivity of the receptor apparatus of the membranes, and consequently to a violation of the neuro-endocrine regulation of metabolic processes, leading to an exacerbation of concomitant chronic diseases: bronchial asthma, pyelonephritis, rheumatoid arthritis, etc.

The objective of the invention is to provide a highly effective method of treating chronic cystitis, which allows to obtain a more pronounced and lasting therapeutic effect and reduce the risk of side effects.

The essence of the invention lies in the fact that a method of treating chronic cystitis is characterized in that an ozonized physiological solution is injected into the patient's body for 10 days daily against the background of electrotherapy by the mesodiencephalic modulation method, in the first 5 days, the ozonized solution is administered intravenously with an ozone concentration of 9 mg / l in a volume of 400 ml with the addition of 200 mg of cocarboxylase, 2 ml of a 0.5% solution of thiamine bromide, and in the next 5 days, the ozonized solution is administered as endovascular instillation at an ozone concentration 9 mg / l in a volume of 100 ml, while the treatment is carried out in the acute stage, before which on the 7th day the number of leukocytes and ESR are determined in the patient’s blood, the number of leukocytes and the level of bacteriuria in the urine, and with a decrease in these indicators relative to the initial course treatment continues according to the scheme.

Using the invention allows to obtain the following technical result.

The method is highly effective. It allows you to get a more pronounced therapeutic effect, which is manifested in the improvement of the clinical symptoms of the disease: a significant reduction or disappearance of pain, dysuria, improvement of the general condition.

In a clinical blood test, there is a decrease in leukocytosis, a decrease in ESR, in a urinalysis a decrease in leukocyturia. Microbiological urine culture reveals a decrease in the level of colonization of inoculated flora. A controlled instrumental study - cystoscopy with a biopsy show a significant reduction in signs of inflammation of the bladder mucosa. According to uroflowmetry, urodynamic indicators improved to physiological values (Q max, Q ev).

The resulting therapeutic effect is persistent, remission periods are extended.

As a result of treatment, the period of disability is reduced.

The consumption of expensive medications is reduced, including antibiotics, uroantiseptics, antidysuric drugs, which prevents the occurrence of side effects, allergic reactions, the development of dysbiosis and the emergence of antibiotic-resistant strains as one of the causes of chronicity and repeated relapses of the inflammatory disease.

The method has limited contraindications: blood diseases associated with impaired blood coagulation properties, a tendency to bleeding.

Possible minor side effects of ozone therapy - phlebitis in the intravenous area are easily stopped and are transient in nature.

Using the method allows to expand the possibilities of ozone therapy, namely the antiseptic properties of ozone in chronic cystitis, to stimulate non-specific protection and cellular immunity of the body.

The technical result is achieved through the integrated use of ozone therapy against the background of mesodiencephalic modulation (MDM), aimed at the rapid delivery and intensive penetration of biologically active substances, with the neutralization and destruction of the infectious agent and the further restoration of normal organ function.

Ozone refers to physiological oxidizing agents. The target of its action are cell membranes with a dense content of lipids and proteins. The reaction of ozone with carbohydrate bonds leads to the formation of ozonides, which trigger the synthesis of biologically active substances and the activation of enzymes, which ensures adequate mobilization of antioxidant protection. 2 hours after the introduction of ozonized physiological saline, an increase in the metabolic activity of neutrophils was noted. The main point of the action of ozone is the restoration of the oxygen-transport function of the blood, optimization of metabolic processes at the cell level, restoration of the energy potential of cells. The sanitizing effect of ozone is associated with exposure to bacteria, viruses and fungi, inhibiting their reproductive ability. The antibacterial effect of ozone may be associated with the activation of immunity. The effect of ozone on microcirculation has been proved, which helps to provide tissue with oxygen (Zmyzgova A.V., Maksimov V.A. Clinical aspects of ozone therapy). M .; 2003.p. 43-49. Leontiev G.V. The use of ozone therapy for the correction of energy metabolism in case of multiple organ failure (p. 34-37).

Indications for ozone therapy: correction of metabolic processes in purulent-septic diseases, due to the energy efficiency of oxidative processes, increased oxygen concentration in the blood, increased glucose metabolism in the liver and tissues. Thus, the anti-inflammatory effect of antioxidant protection is provided, stabilization of antioxidant protection and plastic metabolism in tissues.

MDM restores the disturbed mechanism of regulation of physiological processes, i.e. the ability of nerve structures to regenerate nerve impulses, improve redox reactions, activate blood flow and metabolic processes in cells and tissues. Under the influence of MDM there is a restructuring of intercentral relationships. It was established that the influence of the pulsed current occurs mainly on the subcortical-stem sections of the brain (hypothalamus, pituitary, reticular formation), i.e. to important vegetative-endocrine centers of regulation of various physiological functions of the body. The activation of these zones leads to an increase in the yield of biologically active compounds - neuropeptides, which leads to an increase in the efficiency of adaptation and a decrease in the severity of the stress reaction to the inflammation process.

The combination of ozone therapy and MDM improves the effectiveness of treatment due to the synergism and prolonged action of these two therapeutic factors. On the one hand, ozone has an anti-inflammatory and antioxidant effect on cell metabolism, on the other hand, MDM regulates the processes of homeostasis, activates energy metabolism in tissues and, at the same time, both factors increase the reactivity of the immune system, while both local and general immunity increase.

The authors worked out the treatment algorithm: doses and concentrations of drugs, the duration and frequency of their administration. A different scheme does not allow us to solve the problem.

The method is as follows.

A patient with chronic cystitis in the acute stage on the background of electrotherapy by the method of mesodiencephalic modulation (MDM) is injected intravenously with an ozonized solution of 0.9% sodium chloride with an ozone concentration of 9 mg / l in a volume of 400 ml with the addition of cocarboxylase 200 mg, a solution of 0.5 thiamine bromide % 2 ml as an antioxidant. For this purpose, through a solution of a 0.9% solution of sodium chloride, which is in a standard bottle with a capacity of 0.5 liter, a needle having several lateral openings is inserted through a hermetically sealed stopper, through which an oxygen-ozone gas mixture obtained at an ozonizer installation of the company MEDAZON ”with an ozone concentration of 50 mg / l for 5 minutes, which makes it possible to obtain an ozone solution concentration of 2 to 9 mg. Within 15-30 minutes, a stable concentration of ozone in the solution is maintained, therefore, intravenous injection is administered in this time interval. The drug solution is injected into the ulnar vein at a speed of 40-50 drops per minute. The therapeutic dose of ozone is 0.8-2.4 mg per 70 kg of body weight.

MDM is carried out using the apparatus MDM 201 - single-channel, on the bed in a supine position. Electrodes with cloth pads moistened in warm boiled water are fixed on the patient's head. The electrode system is placed on the patient’s head so that the cable is in the region of the patient’s left ear, and the electrode with a red mark is located on the patient’s forehead. By adjusting, an appropriate current value is established based on the accepted treatment technique. The current increases until the sensation of “compression of the head” appears, which corresponds to the active influence of an electric signal on the mesodiencephalic structures of the brain. Current control is performed by an ammeter on the front panel.

In this case, before and on the fifth day after the introduction of ozone solutions, laboratory tests are performed - a clinical blood test, a clinical analysis of urine and urine culture for bacteriuria (Table 1), as well as instrumental studies - ultrasound, cystoscopy with biopsy and uroflowmetry. In the absence of positive dynamics in laboratory and instrumental indicators compared with the initial level on day 5, repeated intravenous ozonized physiological saline is administered according to the same procedure.

The method has passed clinical trials in 20 patients (volunteers) with a diagnosis of chronic cystitis at the acute stage.

By day 2-3, there was an improvement in general condition, a decrease in pain syndrome, relief of dysuria, a decrease in leukocytosis and ESR was noted in a clinical blood test, and a decrease in leukocyturia in a urinalysis. At the end of the course of ozone therapy, a marked decrease in inflammatory manifestations was noted compared with baseline levels. In 90% of cases, elimination of microorganisms according to urine culture is noted. The data obtained indirectly indicate the antibacterial effect of ozone therapy (Table 1).

Thus, an effective method for the treatment of chronic cystitis in the acute stage is proposed.

Example 1. Patient M., 52 years old, turned to a urologist with complaints of frequent painful urination, pain in the lower abdomen, frequent nightly urination up to 5 times. A history of chronic cystitis, worsening of about 3 days. Clinical diagnosis: chronic cystitis recurrent course in the acute stage.

Objective data: General condition is satisfactory. The physique is correct. Food is moderate. The skin is clean. The mucous membranes are pale. The chest is symmetrical, evenly participates in the act of breathing, vesicular breathing. Respiratory rate 20 in 1 minute. The heart region without features. The boundaries of the heart are within normal limits. Heart sounds are clear, rhythmic, heart rate 72. HELL 120/70. The abdomen is symmetrical, soft, moderately painful in the suprapubic region. Laboratory data: in blood tests: hemoglobin 123 g / l, white blood cells 9000, eosinophils 8, ESR 23. Biochemical blood test: creatinine 84 mol / l, urea 6.2 mmol / l, uric acid 340 mmol / l. Lipid profile without features.

The patient underwent 5 sessions of ozone therapy: 400 ml of saline with an ozone concentration of 9 mg / l was injected into the cubital vein. Only 5 sessions on the background of MDM. On the 5th day they decreased: pain, dysuria, the general condition improved, in the analysis of urine, leukocyturia decreased, leukocytosis and ESR decreased, according to uroflowmetry, the average urine flow increased. On day 10, laboratory tests met physiological norm. On day 12, the patient recovered working capacity.

Example 2. Patient N., 73 years old. Diagnosis: chronic cystitis in the acute stage. Concomitant diagnosis: hypertension, diabetes mellitus INT, considers himself a patient for about 2 years, over the past six months, 2 exacerbations of chronic cystitis. Deterioration after suffering acute respiratory infections. When contacting a urologist, complaints of frequent urination, a feeling of heaviness in the lower abdomen, general malaise, lethargy. Upon examination, the condition is satisfactory. The skin is clean, pulse 72 min, rhythmic, blood pressure 150/85. Vesicular breathing. The abdomen is soft, pain on palpation in the lower abdomen. Pasternatsky’s symptom is negative.

Clinical blood test: Hemoglobin 118 g / l, white blood cells 10.2 g / l, ESR 21 mm / h. Urinalysis: 1008, white blood cells 18-20 in the field of vision, red blood cells 6-7, a lot of mucus, bacteria. Biochemical an. blood: protein 65 g / l, cholesterol 7.4 mmol / l, creatinine 72, urea 6.3, uric acid 340, ACT 40, ALT 18, blood sugar 5.3. Cystoscopy data: mucosa with signs of vascular injection. In the neck of the bladder there is bullous edema. Conclusion: signs of chronic bullous cystitis. Biopsy data: replacement of the transitional epithelium by stratified, flat with enlargement and polymorphism of nuclei in the basal and middle layers, the formation of Bruno glands was found. In the own plate of the mucosa, pronounced inflammatory lymphohistiocytic infiltration. Conclusion: chronic cystitis with the formation of Bruno glands and the development of intraepithelial neoplasia 1 tbsp. Uroflowmetry: Average urine flow 8 ml / sec.

The patient underwent 5 sessions of ozone therapy in combination with endovascular administration of an ozone solution (10 sessions) against MDM (10 sessions). On the 5th day after the start of treatment, pain and dysuria decreased, in the clinical analysis of blood leukocytosis and ESR decreased, in the clinical analysis of urine - leukocyturia decreased, with cystoscopy - less pronounced symptoms of bullous inflammation. On day 10, the feeling of heaviness in the lower abdomen did not bother, and dysuria became insignificant. According to laboratory tests of blood and urine indicators within the physiological norm. Biopsy data: areas of the replacement of the transitional epithelium with the multilayer with the polymorphism of the nuclei in the basal layers are preserved, lymphohistocytic infiltration decreased. Conclusion: chronic cystitis. Uroflowmetry: average urine flow of 16 ml / sec (a significant increase compared with the initial data).

Laboratory results before and after ozone therapy in combination with MDM.

Table 1 №№ The number of patients (n = 20) Analysis of urine Blood analysis Bacteriuria CFU units number of patients Uroflowmetry L in p / sp Er in p / sp L-cytes ESR in mm / hour one Initial data Up to 50 Up to 10-15 9.3 24 > 5 × 10 ² 10 ³ n = 18 Qev-10 2 5 days after treatment Up to 20 Up to 7-8 6.4 17 <5 × 10 ² 10 ³ n = 15 Qev-14.5 3 10 days after treatment Up to 6-8 Up to 1-3 4.2 12 <10 ² 10 ² n = 16 Qev-17

Claims (1)

A method of treating chronic cystitis, characterized in that the patient is injected with an ozonized saline solution for 10 days daily against the background of electrotherapy by the mesodiencephalic modulation method, in the first 5 days the ozonized solution is administered intravenously with an ozone concentration of 9 mg / l in a volume of 400 ml with the addition of 200 mg of cocarboxylase, 2 ml of a 0.5% solution of thiamine bromide, and in the next 5 days, the ozonized solution is administered as endovascular instillations at a concentration of ozone of 9 mg / l in a volume of 100 ml, while This is carried out at the stage of exacerbation, before which, on the 7th day, the number of leukocytes and ESR in the patient’s blood is determined, the number of leukocytes and the level of bacteriuria in the urine are determined, and with a decrease in these indicators relative to the initial ones, the course of treatment is continued according to the scheme.