RU2127595C1 - Method of treatment of patients with inflammatory sickness of female gonads in reproductive age - Google Patents

Abstract

FIELD: medicine, gynecology. SUBSTANCE: method involves administration of carbon-mineral sorbent SUMS-1 at the dose 1 g at exudation phase for 3-5 days followed by administration of biopreparation in tampons for 5-7 days. EFFECT: decreased time of treatment. 2 tbl, 2 ex

Description

 In recent decades, a wide variety of treatment regimens have been proposed for treating inflammatory diseases of a woman’s genitals, using new antibiotics, increasing the doses of well-known drugs many times over, resorting to various combinations between them and other means. However, this did not allow to reduce either the recurrence rate of these diseases, nor the frequency of the process chronicity. In addition, the overly broad and irrational use of antibiotics has led to a number of undesirable consequences. At present, it has been proven that antibiotics are immunosuppressants, inhibit the nonspecific defense of the body.

 The effectiveness of treatment with antibacterial drugs decreased for several reasons: due to the growth of strains resistant to the antibiotics used, the increase in adverse reactions, increasing allergization of the human body, and a gross violation of the vaginal microecology. All of the above attracts researchers to the development of new therapeutic agents for women suffering from inflammatory diseases of the genitals.

 We have taken as a prototype a method for the treatment of inflammatory diseases of the female genital organs in combination with the local use of the drug polyzhanaks - globules containing 35,000 M. neomycin and polymyxin B and 100,000 M.E. nystatin (Bruhat M.A. Plase d'une association antibiotique locale dans le traitement des aginites mycosiques et vaginites mixtes. // Rev. fr. Ginecol. Obstet. 1992, 87.3). However, it does not completely relieve the inflammatory reaction, does not destroy the coccal flora, and does not restore vaginal microbiocinosis.

 We propose a method for the treatment of inflammatory gynecological diseases, based on the introduction of powdered SUMS-1 on a tampon (1 g) into the vagina, for 3 to 5 days in the exudation phase against the background of conventional therapy with investigating the restoration of normal vaginal microflora with biologics (lacto- or bifidumbacterin) .

 The SUMS-1 preparation was developed in the State Register of the Ministry of Health of the RSFSR (N 93/174/7). It is a carbon mineral sorbent based on the mineral product of aluminum hydroxide, onto which carbon is deposited by carbon pyrolysis (L. Rachkovskaya et al., 1982). The sorbent (without additional coatings) is intended for contact with the wound surface (including through the membrane) in order to remove various toxic substances and microbial cells from gram-positive and gram-negative cells from purulent-inflammatory diseases. The sorbent does not have a general toxic and allergic effect on the human body. Powdered carbon-mineral sorbent SUMS-1 is a microgranule (close to spherical) with a size of 50 - 150 microns. The mass fraction of the working fraction of the sorbent is not less than 85 - 90%.

 The sorption characteristics of the sorbent were studied at the Siberian Branch of the Academy of Sciences (Gavrilov V.Yu. et al., 1983; Rachkovskaya LN et al., 1983). The extraction of cells of pathogenic Staphylococcus aureus and Escherichia coli was 60 - 70%.

 The method is as follows. A gynecologist conducts a clinical examination of the patient, on the basis of which he makes a diagnosis. A clinical examination usually includes a medical history, special gynecological examination, blood tests, urine tests, determination of C-reactive protein, fibrinogen, blood sugar, ALT, AST, bacterioscopy, bacteriology, ultrasound examination of the pelvic organs. If an inflammatory process is detected (for example, salpingitis, salpingoophoritis, endomyometritis, metroendometritis), the patient is prescribed antibiotics of a wide spectrum of action, the severity of the connection may include sulfonamides and (or) nitrofurans, an antihistamine, B vitamins and ascorbic acid. These treatment regimens are generally accepted (Savelyeva G.M., Antonova L.V., 1978; Kulakov V.I. et al., 1978), and therefore we do not dwell on them in more detail.

 In severe bacterial-toxic form of the disease (metroendometritis after childbirth, infected or criminal abortion, salpingoophoritis, salpingitis, etc.), symptomatic, infusion, detoxification therapy is carried out. With severe pain, sedative sedative therapy is prescribed. Hemostatic drugs, cold, physiotherapy are possible. After examining the gynecologist, examining and identifying the exudation phase in the patient, tampons with SUMS-1 are prescribed for 2 to 5 days, then for 5 to 7 days, tampons with biological products.

 The method was tested for 50 patients of the gynecological hospital N 2 of Novosibirsk, aged 18 to 42 years. The distribution of patients by disease is given below: 1.

Gynecological diagnosis - Number of patients treated
Acute endomyometritis after artificial abortion - 10
Acute endomyometritis after childbirth - 10
Acute purulent salpingitis - 15
Exacerbation of chronic salpingo-oophoritis - 15
Total - 50
The effectiveness of therapy was evaluated by clinical and laboratory data and a cytomorphological study of the contents of the vagina and cervical canal.

 In the treatment with polygynax, the partial effect is that in the absence of inflammatory changes in the uterine appendages, the woman continued to be bothered by leucorrhoea and active neutrophils, macrophages, lymphocytes, zosinophils, mast cells (7-10-15 in total), a moderate amount of flora and the absence of B. Vaginalis was observed in 50% of patients; there was no effect in 13.66%.

 The cytomorphological composition of the vaginal contents before and after treatment of inflammatory gynecological diseases with polygynax is presented in the table.

 After our treatment with powdered SUMS-1, in 100% of cases, isolated lymphocytes and plasma cells were found in the separable from the vagina and cervical canal, microflora was absent. After the introduction of vaginal swabs with lacto- or bifidumbacterin, normal microflora was restored.

 The results obtained indicate that sorbents carry out local detoxification, thereby reducing the inflammatory process in a shorter time.

Case Studies
Patient H., medical history N 1459, was admitted to the gynecological hospital N 2 of Novosibirsk. After the examination, the diagnosis was made: Exacerbation of chronic right-sided salpingoophoritis, metritis. Adhesive periadnexitis.

 Against the background of conventional therapy, the patient from the first day introduced tampons with SUMS-1 for three days.

 Before treatment with a special gynecological examination, it was revealed: hyperemia of the cervical mucosa around the external pharynx. The body of the uterus is softish, painful, the appendages on the right are pasty, painful, on both sides the appendages are thickened, the discharge from the cervical canal is purulent, plentiful.

 Bacterioscopy: white blood cells completely, microflora coccal, a large number, B. Vaginalis - no.

 Cytomorphology: neutrophils: “active” - 36%, “inactive” - 14; macrophages: "active" - 8%, "inactive" - 0%; lymphocytes - 26%; plasma cells - 14%; zosinophils - 2%; mast cells - 0%.

 Bacteriologically identified Streptococcus faecalis, massive growth.

 After three days of treatment, the symptoms of intoxication disappeared, the pain decreased significantly. A gynecological examination determined thickened appendages on both sides, sensitive to palpation, mucous discharge from the cervical canal, moderate.

 Single leukocytes in the field of vision were determined bacterioscopically; there was no flora.

 Cytomorphology: single lymphocytes.

 Bacteriology: no growth detected.

 The patient was canceled antibacterial drugs, prescribed physiotherapy, cyclic vitamin therapy, topically: vaginal tampons with lactobacterin for 5 days.

 After treatment: single lymphocytes and B. Vaginalis in smears.

 Patient M., medical history N 1298, was admitted to the gynecological hospital N 2 of Novosibirsk. After the examination, the diagnosis was made: Acute endomyometritis after spontaneous abortion during pregnancy 9 - 10 weeks.

 Gynecological examination revealed: the cervix is cylindrical, the external pharynx was open by 0.7 cm. The body of the uterus was enlarged to 5 weeks of pregnancy, soft, painful. Discharge from the cervical canal is blood-purulent, plentiful.

 Bacterioscopy - white blood cells - completely, microflora varied - a large number, B. Vaginalis was not.

 Cytomorphology: neutrophils: “active” - 48%, “inactive” - 19%; macrophages: "active" - 14%, "inactive" - 0%; lymphocytes - 5%; plasma cells - 12%; eosinophils - 0%; mast cells - 1%.

 Bacteriology: no growth detected.

 Against the background of conventional therapy, the patient underwent local treatment of SUMS-1 for 5 days.

 Against the background of the therapy, on the third day the woman's body temperature returned to normal, her general condition improved, her appetite improved, on the fourth day the pains in the lower abdomen, discharge from the genital tract disappeared. During a gynecological examination on the 5th day of treatment: the cervix is cylindrical, the external pharynx is closed, the uterus is almost normal in size, soft, painless, mucous, scanty discharge from the cervical canal.

 Bacterioscopically, cytomorphologically, almost no cells were detected, no flora.

 Bacteriology: no growth detected.

 The woman was continued local treatment with lactobacterin for 7 days. After that, the normal flora of the vagina was restored.

Claims (1)

 A method of treating inflammatory diseases of the female genital organs in reproductive age, which consists in introducing drugs into the vagina, characterized in that they use carbon-mineral sorbent SUMS-1 in the form of a tampon in a dose of 1 g to the exudation phase for 3 to 5 days, followed by administration on tampons biological product to restore normal vaginal microflora within 5 to 7 days.

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