RU2466746C1 - Method of treating patients suffering infertility caused by tubal obstruction and anovular menstruation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: there are involved the paracervical introduction of a mixture containing isoniaside 600 mg, hemase 5000 units, 2% novocaine 4.0 ml, prednisolone 50.0 mg once a day. The therapeutic course makes 10 days including a period of menstruation. They are separated by pauses of 5-10 days.

EFFECT: complete recovery of pelvic tuberculosis, recovery of ovarian function and tubal obstruction ensured by simultaneous effect of various pathogenesis links of the given pathology.

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Description

The invention relates to medicine, namely to gynecology, and can be used to treat patients with infertility due to anovulation, adhesions of the pelvis, tubo-ovarian infertility, tubo-ovarian inflammatory formations with a dense capsule that persists after 3-5 months of chemotherapy, sactosalpinx, a combination of genital tuberculosis with "symptomatic" uterine myoma, endometriosis, cysts and ovarian cysts, appendage tuberculomas in the background of chronic pelvic tuberculosis after th treatment in specialized clinics gynecologists phthisiatricians.

The following methods for the treatment of tuberculosis of the pelvic organs are known.

1. For tuberculosis of the uterine appendages with severe inflammatory changes, it is recommended to use three drugs within 4-6 months: isoniazid, streptomycin and rifampicin. Then one of the drugs is canceled, and two continue to take another 8-12 months. At stage 1, isoniazid is administered intravenously or intramuscularly. (Kolachevskaya E.N. “Tuberculosis of the female genital organs”, ed. “Medicine”, Moscow, 1975, chapter 4, pp. 80-90).

2. The treatment program for patients with genital tuberculosis provides a long course of 6 to 24 months using rifampicin 450-600 mg per day, streptomycin 0.5-1 g per day, isoniazid 300 mg per day, pyrazinamide 1.5-2 g per day ethambutol 15-30 mg / kg per day. Second-line drugs are administered as follows: kanamycin 1000 mg per day, amikiacin 10-15 mg / kg per day, lomefloxacin 400 mg 2 times a day. ("Gynecology", edited by V.I. Kulakov, G. M. Savelieva, I. B. Manukhina, publishing group "GEOTAR MEDIA", 2007, chapter 60, p. 614).

3. Closest to the claimed is a method of treating tuberculosis of the uterus with the presence of tuberculosis, including chemotherapy for 1-2 months, as a preoperative preparation. For treatment, isoniazid 300 mg per day is used with rifampicin 450-600 mg per day. Isoniazid is administered intravenously or intramuscularly. For tuberculosis with a pronounced inflammatory process, it is recommended to use three anti-TB drugs: isoniazid 300 mg per day, streptomycin 0.5-1 g per day and rifampicin 450-600 mg per day, or isoniazid 300 mg per day, ethambutol 15-30 mg / kg per day and ethionamide 500-750 mg / kg per day. Then one of the drugs is canceled, and two continue to take another 8-12 months.

(A Practical Guide to Anti-Infectious Chemotherapy. Edited by L. S. Strachunsky, Yu. B. Belousov, S. N. Kozlova, NIIAH SGMA Publishing House, 2000-2007, p. 28).

Relapses are observed in approximately 7% of patients, 2.7% of patients with genital tuberculosis become disabled. The causes of disability are adhesive disease and fistulous forms of genital tuberculosis. Reproductive function is restored in 5-7% of patients. (“Gynecology”, edited by V.I. Kulakova, G.M. Savelyeva, I.B. Manukhina, publishing house: Association of Medical Communities in Quality. Publishing Group GEOTAR - Media. 2009, chapter 20.11, p. 386, 387).

Known methods have several disadvantages:

 1. all anti-TB drugs are administered intravenously or per os, no more than 3% of the tubostatic agent penetrates into the pelvic organs, therapy can last several years and is a debridement of the pelvic organs to prepare for IVF or surgery;

2. It is necessary to continuously administer high doses of anti-tuberculosis drugs with high toxicity;

3. The above methods are not able to cure pelvic organs from tuberculosis, but translate the acute process into a chronic one;

4. diseases such as tuberculomas of the uterine appendages, tubo-ovarian inflammatory formations with a tight capsule, sactosalpinx, a combination of genital tuberculosis with "symptomatic" uterine myoma, endometriosis, cysts and ovarian cystomas require surgical intervention, which in turn leads to metastasis of tuberculosis.

The objective of the invention is to provide a highly effective method of treating patients with infertility due to obstruction of the fallopian tubes or anovulatory menstrual cycle against the background of chronic tuberculosis of the pelvic organs.

The problem is solved due to the fact that in the method of treating pelvic inflammatory disease in the presence of chronic tuberculosis using tubostatics, isoniazid is used as a tubostatic, and treatment is carried out with paracervical administration of a mixture containing 600 mg of isoniazid, 5000 IU of hemase, 4.0 ml 2 % solution of novocaine and 50.0 mg of prednisone 1 time per day with a course of treatment 10 days before recovery, including the period of menstrual bleeding, with a break between courses of 5-10 days.

Treatment is carried out using the following drugs.

Isoniazid - an anti-TB drug - hydrazide 4 - pyridine carboxylic acid. It inhibits DNA-dependent RNA polymerase and stops the synthesis of mycolic acids of mycobacterium tuberculosis. It is especially active against rapidly multiplying microorganisms (including those located intracellularly) (MD Mashkovsky “Medicines”, vol. 2, p. 323).

Prednisolone is a synthetic glucocorticoid for systemic and topical use. It has anti-inflammatory, anti-allergic, anti-shock, immunosuppressive, anti-exudative, antiproliferative effects. Its anti-inflammatory and anti-allergic activity is 3-4 times higher than the activity of cortisone or hydrocortisone. (MD Mashkovsky “Medicines”, Volume 2, p. 33).

Gemaza - prourokinase - fibrinolytic and thrombolytic drug, which is a serine protease. Prourokinase specifically stimulates the conversion of profibrinolysin (plasminogen) to fibrinolysin (plasmin), an enzyme that can lyse fibrin clots. (Publishing house "MEDIZDAT" "Journal of the Practitioner", No. 2, 2003, p.21)

Using the proposed method for the treatment of patients with infertility due to obstruction of the fallopian tubes or anovulatory menstrual cycle against the background of chronic tuberculosis of the pelvic organs, leads to the restoration of patency of the fallopian tubes, removal of the inflammatory process in the endometrium, fallopian tubes, ovaries, and restoration of ovulation.

This method allows for a short course to carry out anti-tuberculosis, anti-inflammatory and absorbable therapy. Reduces the daily dose of isoniazid by 2 times. Contraindications to the treatment with this method: pulmonary hemorrhage, active tuberculosis, oncology of any localization.

The invention is illustrated by examples.

Example 1

Patient M. 32 g. From the anamnesis: tuberculosis of the right lung, pulmonary hemorrhage. Tubostatics were treated for 2 years. Against the background of treatment after 2.5 years, left-sided ectopic pregnancy, abdominal surgery. Tubo- and ovariectomy on the left. The histological conclusion: tuberculosis of the fallopian tube and ovary, ectopic pregnancy for a period of 4 weeks.

Diagnosis: Chronic metroendometritis, right-sided salpingo-oophoritis. Hydrosalpinx on the right. Severe adhesive disease of the pelvic organs. Tuberculosis of the pelvic organs. Infertility 5 years. On examination: the uterus is enlarged, sharply painful on palpation. On the right, the appendages are soldered to the right rib of the uterus, enlarged, sharply painful. Ultrasound results: the uterus is enlarged in size 55 mm × 50 mm × 45 mm, the structure is heterogeneous, signs of endometritis. The appendages on the right are enlarged in size 42 mm × 40 mm × 43 mm, the contours are fuzzy, the follicular apparatus is not pronounced.

The treatment was carried out: paracervical administration of a mixture containing 600 mg of isoniazid, 4.0 ml of a 2% solution of novocaine, 5000 IU of hemase, 50.0 mg of prednisone once a day. 4 courses of 10 days were taken, including the period of menstrual bleeding. A break every 10 days 5-10 days. At the end of treatment, according to hysterosalpinography, the right tube is passable. After 3 menstrual cycles, pregnancy began. Childbirth live full-term fetus male sex, weight 4200, height 52 cm, healthy.

Example 2

Patient N. 26 years. From the anamnesis: for 5 years was observed with a diagnosis of tuberculosis of the lower lobe of the right lung. Repeatedly treated with tubostatics.

Diagnosis: Chronic metroendometritis, bilateral salpingo-oophoritis against the background of tuberculosis of the pelvic organs. Anovulation. Adhesive disease of the pelvis 3 degrees. Primary infertility 3 years.

On examination: the uterus is enlarged, sharply painful on palpation, fixed. Appendages on both sides are soldered to the uterus, enlarged, sharply painful on palpation. Adhesions are palpated in all areas of the pelvic organs. Ultrasound results: the uterus is enlarged, the contours are fuzzy, signs of endometritis. The appendages on the right are enlarged in size - 46 mm × 50 mm × 50 mm, the contours are fuzzy, the capsule is thickened, the follicular apparatus is not pronounced. On the left, the appendages are also enlarged in sizes of 50 mm × 46 mm × 50 mm, the contours are fuzzy, the capsule is thickened, the follicular apparatus is not expressed.

The treatment was carried out: paracervical administration of a mixture containing 600 mg of isoniazid, 4.0 ml of a 2% solution of novocaine, 5000 IU of hemase, 50.0 mg of prednisolone, 1 time per day. The course of treatment is 10 days. Conducted 6 courses, including the period of menstrual bleeding. A break every 10 days 5-10 days. As a result, according to hysterosalpinography, both pipes are passable. After 8 menstrual cycles, pregnancy began. Childbirth live full-term female fetus, weight 3100, height 50 cm, healthy.

Example 3

Patient, 38 years old. From the anamnesis: 18 years suffering from tuberculosis of the pelvic organs, repeatedly underwent chemotherapy. Married for 8 years. Pregnancy did not occur. The pipes are passable.

Diagnosis: Chronic metroendometritis, bilateral salpingo-oophoritis against the background of chronic tuberculosis of the pelvic organs. Anovulatory menstrual cycle. Adhesive pelvic disease. Primary infertility is 8 years. On examination: the uterus is enlarged, sharply painful on palpation. Appendages on both sides are enlarged, sharply painful on palpation. Ultrasound results: the uterus is enlarged, the contours are fuzzy, signs of endometritis. Appendages on the right are 50 mm × 50 mm × 48 mm in size, the contours are fuzzy, the follicular apparatus is not pronounced. The appendages on the left are 51 mm × 49 mm × 50 mm in size, the contours are fuzzy, the follicular apparatus is not pronounced. The treatment was carried out: paracervical administration of a mixture containing 600 mg of isoniazid, 4.0 ml of a 2% solution of novocaine, 5000 IU of hemase, 50.0 mg of prednisolone once a day. The course is 10 days. 10 courses were carried out, including the period of menstrual bleeding. A break every 10 days 5-10 days. After 5 menstrual cycles, pregnancy began. Childbirth live full-term male fetus, weight 3600, height 52 cm, healthy.

Claims (1)

A method of treating patients with infertility due to obstruction of the fallopian tubes and anovulatory menstrual cycle against the background of chronic tuberculosis of the pelvic organs using tubostatic, characterized in that isoniazid is used as a tubostatic, and treatment is carried out with paracervical courses of a mixture containing 600 mg of isoniazid, 5000 IU of hemase , 4.0 ml of a 2% solution of novocaine and 50.0 mg of prednisolone, 1 time per day with a course of treatment 10 days before recovery, including the period of menstrual bleeding, with a break between courses of 5-10 days.