RU2522382C1 - Method of treating chronic endometritis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to gynaecology, reflexotherapy and pelotherapy. A method includes carrying out a course of antibacterial and/or antiviral therapy, which is started on 5-7 day of a menstrual cycle. From 5-7 day of the following menstrual cycle a course of pharmacopuncture is performed by introduction of homeopathic preparations into acupuncture points (AP). On 1, 3, 5, 7, 9, 11 and 13 days of the course Traumel C is introduced into points E36 (2), V31 (2), V32 (2), V33 (2), V34 (2). On 2, 4, 6, 8, 10, 12, 14 days of the course Ovarium compositum is introduced in AP Rp6 (2). Simultaneously with the course of pharmacopuncture or starting from 5-7 day of the following menstrual cycle a course of pelotherapy is carried out. Introduction of gel, based on the Dead Sea mud, is performed rectally for 30 minutes, 1 time per day.

EFFECT: method ensures recovery of the two-phase menstrual cycle due to normalisation of endometrium and vagina biocenosis, improvement of local immune and vegetative status, increases duration of remission.

4 cl, 2 ex

Description

The invention relates to medicine, namely to gynecology, reflexology and peloid therapy, and can be used to treat chronic endometritis (CE), including in women with miscarriage.

The frequency of chronic endometritis varies widely - from 0.2 to 67%, averaging 14%. In recent years, there has been a tendency to increase the frequency of chronic endometritis, which is probably due to the widespread use of intrauterine contraceptives, an increase in the number of abortions and various intrauterine manipulations, including endoscopic research methods. The presence of chronic endometritis (CE) is often the cause of reproductive disorders. In 88.2% of women, chronic endometritis develops at a reproductive age and leads to a violation of menstrual, secretory and generative functions. Despite the current treatment regimens for this pathology, the percentage of reproductive disorders remains high. In 59.9% of women with unsuccessful attempts at IVF and embryo transfer, a history of CE was diagnosed. Among women with CE, infertility is diagnosed in 60.4% of cases: primary in 24.8%, secondary in 35.6% (49). More than 70% of women with CE have a history of habitual miscarriage. In this regard, the improvement of existing and the development of new methods of treatment of chronic endometritis remains an urgent task.

Treatment of chronic endometritis includes antibiotic therapy in the first stage, taking into account sensitivity; the second stage involves the use of vasotropic drugs to normalize microcirculation, drugs to improve endometrial receptivity, desensitizing therapy and immunocorrection. The main method of treatment at the second stage is physiotherapy with many recommended methods: pulsed ultrasound, diadynamic currents, electrophoresis with potassium iodide, zinc, lidase, supratonal frequency currents (Strugatsky V.M. Physical factors in obstetrics and gynecology. - M., Medicine, 1981).

However, these methods have the following disadvantages: lack of effectiveness, the duration of the processes of restoration of the endometrium, a large number of relapses, the inhibitory effect of potassium iodide on the processes of folliculogenesis.

A known method for the treatment of chronic endometritis, comprising intramuscularly administering to a patient 1 ml of 1% nicotinic acid solution and applying a low-intensity infrared laser radiation with a wavelength of 0.89 μm, a frequency of 600 Hz, and a pulse power of 5 W to the lower abdomen for 8-10 minutes, daily, a course of 10-12 procedures (RU No. 2233186, C1, 07.27.2004).

The disadvantages of this method of treatment is the low effectiveness of the treatment, in addition, in some patients there is intolerance and the appearance of an allergic reaction to nicotinic acid.

A known method of treating chronic endometritis by introducing into the vagina a gel based on Dead Sea mud. Dead Sea Mud Gel is available in single-use injectors along with single-use vaginal / rectal catheters. One injector contains up to 60 ml of Dead Sea mud gel. In the supine position, a catheter is inserted into the vagina by 8-10 cm and dirt is squeezed out of the injector. The duration of the procedure is 20-25 minutes. Then the dirt is removed from the vagina by douching with boiled water at a temperature of 35-36 ° C. Procedures are carried out daily or every other day. The course of treatment is 6-12 procedures. (http://www.bilifemed.com/_mgxroot/page_10695.html viewed July 2, 2012).

However, this method of treatment is not effective enough. Less than 60% of patients have an effect of treatment, more than 50% of these patients, i.e. patients who received the effect of treatment return with previous complaints within two years. So, out of 38 patients treated by this method, the disappearance of clinical complaints after treatment was noted by 22 patients, remission for more than 2 years was observed in 10 patients. In addition, the vaginal introduction of dirt is not very comfortable for patients.

A known method of treating chronic endometritis, including the use of infusion of medicinal plants and hirudotherapy, which begins on the 5th day of herbal medicine with a course of 16 sessions, with leeches placed in the navel, along the edge of the right costal arch, xiphoid process, coccyx, inside the vagina, perineum, lateral vaginal vaults, to reflex points C3, Th4, VC-2, BG-4, VB-29, VG-20, E-36, RP-6, VC-3, R-18, V-31, F-11, VC-4, VC-7, R-5, F-27, E-29, VC-1 (RU No. 2192268, C1, 11/10/2002).

However, this method of treatment is not effective enough. In addition, the use of leeches is not very comfortable for some patients.

The purpose of the invention is to increase the effectiveness of treatment, increase the comfort of treatment.

This goal is achieved by the fact that on the 5-7 day of the menstrual cycle, a course of antibacterial and / or antiviral therapy is started. After completing the course of drug therapy, on the 5-7th day of the next menstrual cycle, a pharmacopuncture course is started, which includes the introduction of Traumeel C homeopathic medicines to acupuncture points (AT) E36 (2), V31 (2), V32 (2), V33 (2) , V34 (2) on days 1, 3, 5, 7, 9, 11, and 13 of the course of treatment; and Comparium Aquarium in AT Rp6 (2) on days 2, 4, 6, 8, 10, 12, 14 of the course of treatment. 0.2-0.5 ml of the drug is injected into each AT. After a course of pharmacopuncture or simultaneously with it, a mud treatment course is carried out, including the administration of rectally 60 ml of a gel based on Dead Sea mud. The gel is administered in the evening for 30 minutes, 1 time per day, every other day. The course of treatment is 10-12 procedures.

Comparative analysis with the prototype showed that the proposed method of treatment differs from the known one in that it additionally affects AT V32, V33, V34, and at the beginning of treatment, a course of antibacterial and / or antiviral therapy is carried out, which begins on the 5-7th day of the menstrual cycle; then, starting from the 5th-7th day of the next menstrual cycle, pharmacopuncture of homeopathic preparations is carried out, while on the 1st, 3rd, 5th, 7th, 9th, 11th and 13th days, Traumeel C is administered in AT E36 (2), V31 (2), V32 (2), V33 (2), V34 (2), and on the 2nd, 4th, 6th, 8th, 10th, 12th, 14th days - the introduction of Ovarium compositum in AT Rp6 (2). At the same time, 0.2-0.5 ml of a homeopathic preparation is injected into each AT. In addition, additionally, simultaneously with pharmacopuncture or starting from the 5-7th day of the next menstrual cycle, a mud treatment course is carried out using a gel based on Dead Sea mud, which is administered rectally for 30 minutes once a day, in the evening, every other day. The course of treatment is 10-12 procedures.

Thus, the proposed technical solution meets the criteria of the invention of "novelty."

The analysis of patent and specialized literature showed that the proposed method differs not only from the prototype, but also from other solutions in this and related fields. So, the authors did not find a treatment method that would include the proposed regimes, namely, the proposed treatment regimen allows you to relieve pain, eliminate discomfort in the vagina, restore reproductive function, normalize endometrial and vaginal microbiocenosis, improve local immune status and vegetative status, and extend the period remission. The proposed method of treatment is well tolerated, rectal injection of an injector with a gel based on Dead Sea mud is more convenient compared to intravaginal, does not require mud washing after the procedure, the dirt is removed with the act of defecation. In addition, this method of administration allows for a more rapid and "complete" absorption of active substances from the mud. Thus, the proposed method is highly effective and comfortable for patients.

This method can be used in clinics, hospitals, sanatoriums in the treatment of CE.

Thus, the proposed technical solution meets the criteria of the invention "inventive step" and "industrial applicability".

The method is as follows: on the 5-7th day of the menstrual cycle, a course of drug therapy is started taking into account the susceptibility of the detected pathogen, aimed at eliminating the infection (antibiotic therapy, antiviral therapy).

After completing the course of drug therapy, on the 5-7 day of the next menstrual cycle, a treatment course is started, which includes the introduction of homeopathic drugs Traumeel C and Ovarium-compositum in AT. Traumeel C is administered at points E36 (2), V31 (2), V32 (2), V33 (2), V34 (2) on days 1, 3, 5, 7, 9, 11 and 13 of the course of treatment (7 procedures) and the Ovarium compositum is administered at the Rp6 (2) points on the 2nd, 4th, 6th, 8th, 10th, 12th, 14th day of the course of treatment (7 procedures). The procedure is carried out in a prone position. Injections are performed using an insulin syringe, 0.2-0.5 ml of the drug is injected into each AT. The depth of introduction is canonical - until the appearance of the intended sensations (bursting, current flow, burning). The duration of treatment is 14 procedures.

We used preparations of the Biologische Heilmittel Heel GmbH company (Baden-Baden, Germany). All drugs used are approved for use in the Russian Federation in the form of subcutaneous, intracutaneous and intramuscular injections. Registration certificates of the preparations: Ovarium compositum No. 05840/01 dated 07/13/2004, Traumeel C No. 011686/04 dated May 12, 2006.

After a course of pharmacopuncture or at the same time, a mud therapy course is carried out using Dead Sea mud. An injector containing 60 ml of Dead Sea mud gel is administered rectally in the evening for 30 minutes, 1 time per day. Procedures are carried out every other day. The course of treatment is 10-12 procedures. If the mud treatment is carried out after the end of the pharmacopuncture course, then the mud treatment course begins on the 5-7th day of the next menstrual cycle.

Dead Sea Mud Gel Certificate No. FSR 2007/00358, Russia.

Example 1. Patient D., 35 years old.

She complained of miscarriage (frozen pregnancy in the period of 8-9 weeks), perimenstrual scarce spotting for 2 years, periodically pain and burning in the lower abdomen, pain during bimanual examination.

Previously (for 2 years), standard therapy (anti-inflammatory, hormonal, physiotherapy) was carried out, received spa treatment. The treatment did not give an effect.

According to an ultrasound scan performed on the 22nd day of the menstrual cycle, an 8 mm M-echo with single hyperechoic inclusions in the basal layer and a slight decrease in blood flow. Functional diagnostic tests revealed anovulatory cycles.

The result of a histological examination of the endometrium: 6th d.m.s. - stroma dense with diffuse fibrosis; uneven, diffuse lymphoid infiltration - signs of chronic endometritis.

Hormonal background: a decrease in progesterone levels is observed - 1.6 nmol / L (normal 10-89 nmol / L).

Screening for urogenital infections is a negative result.

An examination of the endometrium for opportunistic microflora was conducted with a determination of sensitivity to antibiotics. Were allocated: epidermal staphylococcus> 10 ⁴ CFU / ml with high hemolytic activity; Enterococcus faecalis> 10 ⁶ CFU / m.

Diagnosis: Chronic non-specific endometritis. Secondary ovarian dysfunction as hypoprogesteronemia. Miscarriage.

The treatment was carried out according to the proposed method: starting from the 5th day of the menstrual cycle, antibiotic therapy was carried out, including ciprofloxacin 500 mg 2 times a day for 10 days, tinidazole 500 mg - 4 tablets. per day for 2 days.

Starting from the 5th day of the next menstrual cycle, they underwent a course of treatment that included the introduction of homeopathic medicines Traumeel C and Ovarium compositum in AT. Homeopathic remedies were administered every other day, alternating between the remedies. Traumeel C was administered at points E36 (2), V31 (2), V32 (2), V33 (2), V34 (2) on days 1, 3, 5, 7, 9, 11 and 13 of the course of treatment (7 procedures) and Ovarium compositum was administered at the Rp6 (2) points on the 2nd, 4th, 6th, 8th, 10th, 12th, 14th day of the course of treatment (7 procedures). The procedure was carried out in a prone position. Injections were performed using an insulin syringe, 0.2 ml of the drug was injected into each AT. The depth of introduction is canonical - until the appearance of the intended sensations (bursting, current flow, burning). The duration of treatment was 14 procedures.

After the pharmacopuncture course, starting on the 5th day of the next menstrual cycle, a mud treatment course was carried out using a gel based on Dead Sea mud. 60 ml of the gel was administered rectally in the evening for 30 minutes, 1 time per day, every other day. The course of treatment is 10 procedures.

At the follow-up examination one month after the end of treatment: the patient noted the disappearance of perimenstrual spotting, the absence of pain and burning in the lower abdomen. In the second cycle, the level of progesterone was estimated - its level was 54 nmol / l, which indicates the normalization of the level of progesterone in the blood. A control study of the endometrium was planned, but the woman had a delay in menstruation and, according to ultrasound, a uterine pregnancy was diagnosed, which ended in childbirth on time by a healthy full-term baby. The patient was followed up for 3 years after the birth of the baby. No complaints, menstruation recovered after a year, lactation period was 10 months.

Example 2. Patient W., 26 years old.

Complaints of miscarriage (missed pregnancy in the period of 6 weeks), intermenstrual, meager spotting during 2 cycles, dysmenorrhea during 6 cycles, pain in the lower abdomen, discomfort in the vagina. Somatic - superficial chronic gastritis. Previously, drug therapy and physiotherapy were carried out. The treatment did not give an effect.

Examination for urogenital infections revealed ureaplasmosis> 10 ⁴ CFU / ml, mycoplasmosis> 10 ⁴ CFU / ml by bacteriological culture, PCR diagnosis for HSV and CMV - the infection yielded negative results, ELISA diagnosis for these viruses revealed the presence of Ig M 1:40 to HSV and Ig G 1: 3200 to HSV.

Hormonal background: a tendency to a decrease in progesterone of 20 nmol / L (norm 10-89).

Ultrasound diagnostics: M-echo 7 mm (22 d.s.), single hyperechoic inclusions in the basal layer with reduced blood flow.

The results of a histological examination of the endometrium: the endometrium of the proliferation phase with foci of lymphoplasmacytic infiltration with single neutrophils and eosinophils, periglandular and perivascular, focal fibrosis - a picture of chronic endometritis. Functional diagnostic tests revealed ovulatory cycles with luteal phase deficiency.

Diagnosis: Chronic endometritis. Ureaplasmosis. Mycoplasmosis Herpetic infection, senior aggravation. Miscarriage.

The treatment was carried out according to the proposed method: starting from the 7th day of the menstrual cycle, antibacterial and antiviral therapy was carried out, which included taking at the first stage: unidox solutab 100 mg - 2 tablets. on the 1st day and 1 tab. in the next 8 days, tinidazole 500 mg - 4 tab. per day for 2 days, Valtrex 500 mg 1 tab. 2 times a day for 10 days.

On the 7th day of the next menstrual cycle, a course of treatment was started, which included the introduction of homeopathic drugs Traumeel C and Aquarium Aquarium in AT and mud therapy with a gel based on Dead Sea mud.

The drug Traumeel C was administered at points E36 (2), V31 (2), V32 (2), V33 (2), V34 (2) on days 1, 3, 5, 7, 9, 11 and 13 of the course of treatment (7 procedures ), and the Ovarium compositum was taken to the Rp6 (2) points on the 2nd, 4th, 6th, 8th, 10th, 12th, 14th day of the course of treatment (7 procedures). The procedures were carried out in a prone position. Injections were performed using an insulin syringe, 0.5 ml of the drug was injected into each AT. The depth of introduction is canonical - until the appearance of the intended sensations (bursting, passage of current, burning). The duration of the pharmacopuncture course is 14 procedures.

Simultaneously with the course of pharmacopuncture, the patient underwent a course of mud therapy. 60 ml of Dead Sea mud gel was administered rectally, in the evening, for 30 minutes, 1 time per day every other day. The course of treatment is 12 procedures.

A month after the end of treatment, a control examination showed: the disappearance of intermenstrual bleeding, the absence of painful menstruation, the level of progesterone was 73 nmol / l; Ultrasound - research - M-echo at 23 d.s. amounted to 8 mm with an average blood flow. After 2 cycles, a uterine pregnancy occurred, which is currently bearing.

In total, 64 women with CE were treated with the proposed method. All women after treatment noted:

- the disappearance of pain in the lower abdomen and in the lumbar region;

- normalization of the function of the gastrointestinal tract and urinary system;

- the disappearance of burning in the lower abdomen;

- restoration of secretory and menstrual function, the appearance of a 2-phase menstrual cycle;

- reduction or disappearance of discomfort, dryness and itching in the vagina;

- reduction of pain during bimanual examination;

- restoration of 2 tbsp. purity of vaginal secretion;

- according to the results of the Doppler study, normalization or improvement of the microcirculation of the basal layer in the second phase of the menstrual cycle was noted;

- marked increase in M-echo in all patients with a hypoplastic version of CE.

Patients were monitored for 3 years. For three years, 62 of the patients treated by the proposed method did not present any complaints, 2 women filed previous complaints. During this observation period, 42 patients (65.6%) had pregnancies in a spontaneous cycle and currently 36 pregnancies ended in the birth of healthy full-term newborns, and 6 were born.

Thus, the proposed method can improve the treatment of chronic endometritis, while the proposed method is well tolerated and comfortable for patients.

Claims (4)

1. A method for the treatment of chronic endometritis, including exposure to acupuncture points (AT) V31, E36, Rp6 and the introduction of drugs, characterized in that it additionally affects AT V32, V33, V34, while at the beginning of treatment, a course of antibacterial and / or antiviral therapy that begins on the 5-7th day of the menstrual cycle; then, starting from the 5th-7th day of the next menstrual cycle, pharmacopuncture of homeopathic preparations is carried out, and at the 1, 3, 5, 7, 9, 11, and 13 days, the drug Traumeel C is administered in AT E36 (2), V31 (2) , V32 (2), V33 (2), V34 (2), and on days 2, 4, 6, 8, 10, 12, 14 - the introduction of Ovarium compositum in AT Rp6 (2); in addition, simultaneously with the course of pharmacopuncture or starting from the 5-7th day of the next menstrual cycle, a mud treatment course is carried out, including the introduction of rectal gel based on Dead Sea mud for 30 minutes, 1 time per day. 2. The method according to claim 1, characterized in that 0.2-0.5 ml of a homeopathic preparation is administered into each AT. 3. The method according to claim 1, characterized in that 60 ml of gel based on Dead Sea mud is injected. 4. The method according to claim 1, characterized in that the mud treatment course consists of 10-12 procedures.