SU1237213A1 - Method of treatment of chronic prostatitis - Google Patents

Description

one

The invention relates to medicine, in particular to urology.

The purpose of the invention is to prevent complications in enzyme therapy by determining the titer of antistreptokinase in whole and diluted with physiological saline solution from 2 to 30 times of blood.

The method is carried out as follows.

The antistreptokinase titer is preliminarily set in 1 ml of whole blood, the dose of streptokinase is calculated according to the formula (antistreptokinase titer x X patient body weight kg 100 x), respectively, from 50,000 to 1,500,000 ME. Then, the optimum sutone dose of streptokinase is set equal to or lower by the dose of streptokinase, at which the complete disappearance of the C fraction of fibrinogen occurs during electrophoresis of citrate plasma proteins of blood Mij on a cellulose acetate film. The optimal dose of streptokinase in the treatment of inflammation of the prostate gland should not be accompanied by manifestations of hypocoagulemia. In order to determine the duration of treatment with streptokinase, periodically with an interval of 5-7 days, the titer of antistreptokinase in whole and diluted with physiological 0.9% sodium chloride solution is determined from 2 to 30 times blood. The dilution factor is equal to m 2; five; ten; 20; 30 and determine the ratios of the diluted and whole blood titers based on the dilution factor.

In case of resistance of diluted blood to streptokinase with a resistance index of 2-7.5 units, i.e. when the titer of antistreptokinase changes according to an irrelevant dependence, when a relatively large amount of streptokinase is needed disproportionately to dilute the fibrin clot of a blood, a latent, secondary induced hypercoagulamia and indications for continuing the enzyme therapy of streptocinase to reduce the titre will be used. linear dependence), namely, until the normalization of the resistance index in the range of 0.6-1.5 units.

Example 1. A patient, 60 years old, was admitted to the hospital with complaints of pain.

131

lower abdomen, in the perineum and ichachi and, on frequent urination. He noted periodic go: juvenile pain, increased blood pressure and point hemorrhages on the skin of the whole body. He has been ill for more than 7 years, lnti baktsfialnaya therapy before admission n urology department was ineffective.

On the basis of clinical studies, biochemical analyzes and biopsy material, chronic prostatitis, chronic glomerulonephritis, chronic renal failure, uremia (urea 124 mg% creatinine 4.62 mg), latent DIC S11nd1, hemorrhagic poskulit and t iptenzi (210 / 140 mm Hg).

On admission analysis of urine: beats. weight 1005, protein 1.1%, sugar - negative, sour reaction, leukocytes 50-60-70 in the field of vision, seeing fresh and leached 80-90-10 in the field of vision; blood test: g of chemogin 8 g%, leukocytes 6500, rod-5%, segment-55%, eo-inophiles 3%, basophils 1Z, lymphocytes 32%; monocytes 4%, ROE 68 mm / h. The prothrombin index is 100%, the concentration of fibrinogen in the blood is 1043 mg%, the hematocrit is 25.9%, the total fibrinolytic activity (according to Kotovschikova and Kuznik) is 9.4%, the time of zugululin lysis (according to Kowalski) is 420 min. The titer (a.) Of anti-trepoltok laza in 1 ml of whole blood 800, in blood diluted with saline with a dilution factor

2,100

10 20

1000 600 500

30,250

For 27 days, the patient 5J received a course of enzyme therapy on the background of heparization. Streptokinase from 50,000 to 500,000 ME per day was administered daily to the patient for 24 days, fibrin-lysine from 20,000 to 60,000 units. in a day; Heparin from 12,500 to 25,000 units. on day 22 days Dose per course of treatment: streptokinase 8250000 ME (32 ampoules); fibrinolysin 960000 units (55 bottles); heparin 500,000 units

After 14 days, the titer (a. Units) of anti-streptokinase in 1 ml of whole blood

1237

1000 in blood diluted with saline dilution

Disappeared dot hemorrhages on the skin. Enzyme therapy was continued until the cessation of further antistreptokinase titre.

As a result of enzyme therapy, the patient’s subjective state improved significantly, the swelling and tenderness of the preemptive gland disappeared, diuresis improved, blood pressure decreased to 150/100 mm Hg.

Urine analysis: beats. weight 1005, sour reaction, protein 0.9%, sugar - negative, leukocytes 4-6-10 in the field of view, erythrocytes 0-1-2, blood urea 104 mg / creatinine 0.84 mg%, fibrinogen 444 mg %, hematocrit 23.7%, total fibrinolytic activity 2.5%, euglobulin lysis time 390 min.

At the end of the treatment course, the titer (A. units of anti-streptocitis in 1 ml of whole blood 1200, in blood diluted with a physical solution with a dilution factor

1200

1000

500

300

30250

The resistance index of diluted blood with saline is calculated 30 times using the formula:

30x250 a. units antistreptokinase 1200 a. units whole blood

 6.5 units

Taking into account the good subjective condition of the patient was discharged from the hospital. Intravenous infusions of streptokinase, fibrinolysin and heparin 55 were abruptly stopped.

14 days the patient felt good and no complaints lodged. Through

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2 weeks. Subjective and objective conditions have deteriorated sharply. The patient was re-hospitalized in the nephrology department due to a sharp exacerbation of chronic glomeuronephritis, chronic renal failure and uremia. Conventional therapy is considered ineffective. The patient died of chronic kidney disease and uremia.

Example 2. Patient E., 24 years old, during clinical and biochemical examination diagnosed with exacerbation of chronic prostatitis, impotence.

Total fibrinolytic activity is 14.5%, euglobulin lysis time is 220 min, the titer (a.un.) of anti-streptokinase in 1 ml of whole blood is 50, in blood diluted with physical. solution with coefficients. dilution

50

35

25

ABOUT

For 20 days, the patient received a course of enzyme therapy with intravenous streptokinase 9000000 ME, fibrinolysin 1040000 units, heparin 350000 units. There was a weakly positive accumulation of anti-streptokinase in whole blood.

At the end of the course of treatment, the titer (A. unit) of antistreptokinase in 1 ml of whole blood 200 in blood diluted with saline; with coefficients. dilution

2 5

10 20 30

100 75 50 50 50

The final index of resistance to streptokinase diluted with saline 30 times the blood is calculated by the formula:

50 aa antistreptokinazyk 30

200 aa common blood

 7.5 units

or

50 X 20 200

 5 items

Only the subjective state of the patient improved (pain decreased).

The final diagnosis at discharge: chronic prostatitis in remission. Continuation is required to be treated with streptokinase until normalization of resistance is achieved.

PRI me R 3. Patient B., 71 years of age, was optimized for urinary venous plexus thrombosis and laccapism. A history of chronic prostatitis for more than 20 years, coagulopathy with no vision in the left eye before vascular thrombosis and retinal detachment. Clinical diagnosis at admission to the department: phlebothrombosis of the urogenital venous plethe- PIA, priapism, urinary retention, coagulopathy with secondary induced fibrinolytic activity (DIC). A biochemical study revealed a secondary increased total fibrinolytic activity of 34.6% (a norm of 10–15%), the time of euglobulin lysis was shortened to 210 min (a norm of 300 + 70 min), on the thromboelastogram (TEG) expressed hypo-coagulum (with a maximum amplitude TEG branches only 19 Mt -O Fibrinogen concentration in blood 266 mg%, prothrombin index 75%. As a result of urine retention, 112 mg% in blood, creatinin 1.14 M1%,

The titer (a.) Of anti-streptokinase in 1 ml of whole blood 100, in blood diluted with physiological saline with a coefficient. dilution

76 50

2

five

ten

20

25 o

Upon admission to the department, they started treatment with streptokinase (avellizin) in / in from 250000 to 750000 ME, fibrinolysin of 30,000 units each. and heparin 25,000 units each. in a day. In connection with urinary retention and the effects of uraemia, an operation was performed: a superimposed

45

10 20 30

100

50

Editor L. Pchelinska

The final resistance to streptokinase diluted blood (30) 0.94 units, when diluted 20 times - 1.25 units.

The patient recovered. Compiled by M. Pozn to Tehred M. Morgental Proofreader E. Roshko

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bladder fistula for urine diversion.

After 14 days, the maximum accumulation of titer (a. Units) of anti-streptokinase in 1 ml of whole blood is 3000, and in blood diluted with saline with a coefficient. dilution

Index

JUUU

The total fnbrinolytic activity decreased to 4.9%, the time of euglobulin lysis returned to normal (34–8 min).

The therapy was continued until the indications of antistreptokinase titer in whole and diluted blood were reduced.

Within 70 days, the patient received streptokinase 17550000 ME, fibrinocarcosis 2180000 units, heparin 1100000 units.

Indicators of biochemical analyzes returned to normal: urea 36 mg%, creatinine 0.84 mg%, fibrinogen 4.44 mg%, prothrombin index 85%, total fibrinolytic activity 9.5%, time of euglobulin lysis was extended to 615 mm.

The titer (a.) Antistrepkinskinaz in 1 ml of whole blood 1600, in the blood, diluted with saline with coefficients. dilution

2 5

10 20 30

1000

800

400

100

50

The final value for streptokinase of the blood (30) is 0.94 units, when taken 20 times - 1.25 units.

Claims (1)

(56) Copyright certificate of the USSR No. 1066604, cl. A 61 K 37/48, 1984. METHOD FOR TREATING CHRONIC PROSTATITIS by administering streptokinase to a patient, characterized in that, in order to prevent complications during enzyme therapy, antistreptokinase titers in whole and diluted physiological blood solution are determined, and ratios of diluted whole blood with titers are determined taking into account the dilution coefficient and with a resistance index value of 2-7.5 units. streptokinase treatment is continued until the latter normalizes within 0.6-1.5 units.