[New opportunities of using gialuronidase in chronic prostatitis].

INTRODUCTION: The use of hyaluronidase contributes to improvement in microcirculation, destruction of biofilms and reducing of congestion in patients with chronic prostatitis. Based on this mechanism, the use Longidaza for the diagnosis of latent bacterial prostatitis was suggested. AIM: To evaluate diagnostic and treatment capabilities of the long-acting enzyme preparation Longidaza (rectal suppositories with an activity of 3000 IU), prescribed to patients with chronic prostatitis in routine clinical practice. MATERIALS AND METHODS: A total of 39 men with chronic prostatitis of categories II and IIIa were included in open, prospective, non-interventional, comparative, single-center study. A microbiological study of expressed prostate secretion (EPS) was performed three times, at baseline, after using two suppositories Longidaza 3000 IU and after 7 weeks of therapy. From the 1st to the 10th suppository, Longidaza was used every 48 hours, then, from the 11th to the 20th suppository, it was prescribed every 72 hours. The isolation of the pathogen was an indication for the antibiotic therapy. The treatment outcome was evaluated by using NIH-CPSI scale and laboratory and microbiological analysis of EPS. RESULTS: Diagnostic stage. Initially, pathogens were isolated in 27 (69.2%) patients. The number of leukocytes in EPS averaged 25.9+/-2.3. The use of two suppositories Longidaza increased the number of patients with isolated pathogens to 33 (82%). In 7 out 12 patients with an initial diagnosis of abacterial prostatitis, the use of two suppositories of Longidaza contributed to isolation of the pathogen in EPS (58.3%). The number of leukocytes in the EPS after enzymatic provocation increased by 50.2%. Treatment stage. The number of patients with isolated pathogens decreased from 33 to 7 (17.9%). The pain intensity decreased on average to 2.2+/-0.4 points, and in 27 (69.2%) men dysuria resolved. The quality of life significantly improved up to 1.3+/-0.2 points. The total score on NIH-CPSI scale decreased on average from 17.3+/-1.9 to 3.9+/-0.3 (p<0.05). An increased number of white blood cells in EPS was seen only in 5 (12.8%) men. CONCLUSION: In many cases, bacterial prostatitis remains undiagnosed. Rectal suppositories Longidaza can be recommended for the diagnosis of the latent bacterial chronic prostatitis, since this drug contributes to detection of pathogen and inflammation.

[Rationale of use and effectiveness of Longidaza in patients with chronic prostatitis].

INTRODUCTION: Chronic inflammation of the prostate leads to the formation of excess fibrous connective tissue, which hinders patients recovery and aggravates the symptoms. AIM: This study aimed to confirm the correlation between inflammation and prostatic fibrosis and the abnormalities of urodynamic and microcirculation in the prostate gland in humans, and the possibility of increasing the effectiveness of treatment of patients with chronic nonbacterial prostatitis using antisclerotic therapy. MATERIAL AND METHODS: The study was carried out in two stages. At the first stage, pathomorphological findings, uroflowmetry data and degree of microcirculation disturbance were studied in 18 patients with chronic prostatitis who underwent prostate biopsy. At the second stage, an open prospective randomized comparative study was conducted. Two groups of patients with chronic nonbacterial prostatitis with signs of inflammation were formed. A control group (n=29) received standard treatment, rectal 0.5 methyluracil suppositories three times per week, 20 suppositories per course. In addition to the standard treatment, the patients of the study group (n=31) were administered Longidaza 3000 IU rectal suppositories also three times a week, 20 suppositories per course. RESULTS: Prostatic fibrosis worsens microcirculation by one and half times and statistically significantly negatively affects urodynamic. Using Longidaza resulted in neutralizing the negative consequences of the formation of excess fibrous connective tissue. Overall, an excellent and good effect was achieved in 21 (67.7%) and 9 (29.1%) patients of the study group, respectively; only in one case (3.2%) there was no effect. In the control group, an excellent and good effect was achieved in 14 (48.3%) and 11 (37.9%) patients, respectively; in 4 patients (13.8%) the treatment was considered of low effectiveness. CONCLUSIONS: Prevention of the fibrous connective tissue formation and regression of the fibrosis are pathogenetically valid. Anti-sclerotic enzyme therapy with Longidaza in the form of rectal suppositories results in a significant improvement in the symptoms of prostatitis, an increase in the maximum urinary flow rate and an improvement in the microcirculation of the prostate.

[Acute cystitis do we always need antibiotics?]

We attempted to skip the antibiotic therapy in 17 patients with acute uncomplicated cystitis in the early time of presentation (up to 12 hours from the disease onset). All patients received ketoprofen (Flamax forte) 100 mg once daily for 5 days and the combined herbal preparation KanefronH 2 tablets t.i.d. for 1 month. In 82.4% of patients acute uncomplicated cystitis was cured without antibiotics; 17.6% of cases required additional administration of antibacterial drugs.

[OPTIMAL APPROACH TO COMBINED TREATMENT OF PATIENTS WITH UROGENITAL PAPILLOMATOSIS].

The review analyzed 59 sources of domestic and foreign literature on the use of immunomodulator izoprinozin in treating patients infected with human papilloma virus, and the results of their own experience. The high prevalence of HPV and its role in the development of cervical cancer are shown, the mechanisms of HPV development and the host protection from this infection are described. The authors present approaches to the treatment of HPV-infected patients with particular attention to izoprinozin. Isoprinosine belongs to immunomodulators with antiviral activity. It inhibits the replication of viral DNA and RNA by binding to cell ribosomes and changing their stereochemical structure. HPV infection, especially in the early stages, may be successfully cured till the complete elimination of the virus. Inosine Pranobex (izoprinozin) having dual action and the most abundant evidence base, may be recognized as the optimal treatment option.

[Influence of combined phytotherapy on sexual function in patients with chronic abacterial prostatitis].

An open, prospective, comparative, randomized, placebo-controlled study on the evaluation of the efficacy and safety of combined drug prolit super in patients with chronic abacterial prostatitis without signs of inflammation (NIH 3B category), complicated by sexual dysfunction, was performed. The study included 57 men aged 28 to 50 years. Patients in group 1 (n=29) have received daily 4 capsules of prolit super for 2 months, patients in group 2 (n=28) - placebo for the same period. Excellent results were noted in 58.6% of patients in Group 1 and in 17.9% - in group 2; good results - in 20.7 and 21.4%, satisfactory results - in 20.7 and 17.9%, respectively. Weak effect and its absence were registered only in patients in group 2 - 28.6 and 14.3% of cases, respectively. Significant adverse events or complications against the background of therapy were not observed. The results of the study allows to recommend the appointment of prolit super.in routine clinical practice for patients with chronic abacterial prostatitis without signs of inflammation, complicated by sexual dysfunction.

[Features of the incidence of cystitis depending on the type of contraception].

For the purpose of evaluation the effect of contraceptive methods on the incidence of recurrent bacterial cystitis in women, 215 clinical records of patients with cystitis were analyzed. In addition, incidence of recurrent cystitis in three groups of sexually active women of reproductive age was compared: 26 patients (Group 1) received conventional therapy and used condom as a method of contraception; 31 patients (Group 2) received combined oral contraceptives (COC), and 32 patients (Group 3) received COC and two courses of treatment with canephrone. A negative correlation between COC use and the risk of cystitis was detected. After conventional therapy, recurrences were observed in 43.3% of patients in Group 1, in 25.8% of patients in Group 2, and only in 15.6% of women in Group 3. Thus, the choice of COCs for contraception lead to 2-fold reduction of risk of recurrence of bacterial cystitis, and additional use of canephrone--to 3-fold reduction.

[Importance of individual approach to the immunoprophylaxis of recurrent urogenital infection].

Prevention of recurrence of urinary tract infections by Uro-Vaxom is recommended by domestic and international guidelines; up to date, however, there is no reasonable standard regimen for the use of drug, and long-term results of immunoprophylaxis were not evaluated. The study included 48 patients who received a first course of Uro-Vaxom 5 years ago (2007-2008), including 19 men with chronic bacterial prostatitis/urethroprostatitis and 29 women with recurrent cystitis. Over 5 years, 125 recurrences of urogenital infection were observed; Uro-Vaxom along with antibiotics or uroseptics in combination with phytopreparations was used in 88 (70.4%) cases, and in the remaining 37 (29.6%) cases monotherapy with Uro-Vaxom was used for the relief of inflammatory processes. During the follow-up period, 254 1-month courses of treatment with Uro-Vaxom were conducted; 125 (49.2%) courses were assigned for the treatment of recurrent urogenital infection, and 129 (50.8%)--for the prevention without exacerbation of underlying disease. The main indications for use were intercurrent infection, mainly respiratory--86 (66.7%) cases, stress--14 (10.8%); in 29 (22.5%) cases, the patients have received Uro-Vaxom focusing on their feelings without a doctor's prescription.

[Overactive bladder as a mask of chronic prostatitis].

In order to investigate the frequency of symptoms of overactive bladder (OAB) in patients with chronic prostatitis and determine the effectiveness of trospium chloride in their treatment, the analysis of case histories of 154 patients referred to a urologist for the exacerbation of chronic prostatitis was performed. 27 (17.5%) patients had a diagnosis of overactive bladder; in 19 patients it was accompanied by chronic prostatitis, and in 8 patients OAB was diagnosed as separate disease. All of them have received trospium chloride 30 mg once daily for a month; patients with prostatitis simultaneously have received standard etiopathogenic therapy for this disease. A month later, a comprehensive treatment led to significant positive effect. Urinary frequency decreased by 56.1%, the functional bladder capacity increased by 82.8%, the number of urgent vesical tenesmus was reduced more than by half.

[Efficacy of uro-vaxom in recurrent infectious-inflammatory diseases of the urogenital system].

Our study prospects of urovaxom in improvement of efficacy and prevention of recurrent urogenital infection. One capsule of oral vaccine uro-vaxom was given daily for a month to 127 patients: 23 males with chronic bacterial prostatitis/urethroprostatitis, 75 females with chronic cystitis, 29 females with urolithiasis complicated with secondary chronic pyelonephritis. Control examination was made each two months for a year. In signs of inflammation the patients received one more course of uro-vaxom for a month. It was followed by control examinations each three month for a year. We observed a 6-12 month "cold" period after one course of uro-vaxom in 86.7% patients. After the second course of immunoprophylaxis recurrent urogenital infection occurred 8 times less often. Thus, immunoprophylaxis of urogenital infection with oral vaccine uro-vaxom is highly effective, is well tolerated and, therefore, must enter the standards of medical care for patients with urogenital infection.

[Treatment of patients with resistant urogenital infection].

In our trial 43 patients with urogenital infections resistant to standard therapy received the same basic therapy (4 tablets of safocid a day for 5 days) which, on demand, was combined with pathogenetic and symptomatic treatment. The effect was achieved by both subjective and objective parameters: pathogenic microflora was not detected after 10 days in 39 (90.7%) patients; none of the patients discharged protozoa, fungi. Tests for chlamidia were negative in all the carriers in 2 months, for ureaplasma--in 94.1% males and 83.3% females, respectively. A significant response was observed in 38 of 43 (88.4%) patients, improvement was seen in 5 (11.6%) patients. The above results persisted for 2 months of follow-up.

[A comparative study of efficacy of 2-, 3- and 4-glass tests in patients with chronic prostatitis].

To compare informative value of three tests (2-, 3- and 4-glass) in diagnosis ofprostatitis we examined 177 patients with chronic prostatitis (CP) who were randomized into 4 groups. Group 1 patients (n = 33) were examined with standard 4-glass test (Mearls and Stamey), patients of subgroup 2a (n = 42) were examined with 2-glass test before finger rectal test (FRT), FRT was made in subgroup 2b (n = 45) before urine collection (2 portions), group 3 (n = 57) was examined by an original technique proposed by the authors. While performing the latter test special focus was given to urination continuity, then the secretion obtained at FRT was studied. Efficacy of each of the tests was assessed by comfort of the procedure for the patient and the doctor, a proportion of false-positive results. The 3-glass test proved most informative and significant. Also, it is sensitive in detection of urogenital tuberculosis. The 4-glass test is not comfortable for both the patient and the doctor. The 2-glass test often produced false-positive results.

[Efficacy of combined treatment of women with chronic cystitis associated with intracellular infections].

Forty female patients with urethrocystitis received sparfloxacin in a daily dose 400 mg for 20 days in combination with canefron H (50 drops three times a day for 8 weeks). Twenty patients received one more course of canefron H 4 months after etiopathogenetic therapy. The analysis of the treatment results allows the conclusion that sparfloxacin is highly effective in urethrocystitis associated with intracellular infections. Sparfloxacin provides complete urine sterility. 97.5% females after the combined treatment had no recurrences for a year while before the treatment remission lasted for 4.1 +/- 1.7 months. A preventive administration of canefron H improves microcirculation in the bladder wall and prevents recurrence in patients with urethrocystitis associated with intracellular infections given basic sparfloxacin therapy.

[Approaches to raising efficacy of treatment of patients with chronic prostatitis associated with intracellular infections].

The efficacy of indigal plus containing indol-3-carbinol, epigallocatexin-3-gallat and Serenoa repens extract in combination with sparfloxacin was studied in a trial with participation of 30 patients with chronic infectious prostatitis associated with intracellular agents. Group 1 (n=15) received indigal plus (2 capsules twice a day for 3 months) and sparfloxacin (200 mg twice a day for 1 month). Group 2 including 15 matched controls received sparfloxacin alone according to the same schedule. The examination included questionnaire survey (IPSS, QoL, NIH-CPSI), blood count, urinalysis, PSA test, microscopy, bacteriological study of prostatic secretion, uroflowmetry, transrectal ultrasound investigation of the prostate with residual urine assay, laser doppleroflowmetry. The examinations were performed on the treatment day 30, 60 and 90. After the antibacterial treatment chlamidia, ureaplasma and E.coli were detected in 13.3, 6.7 and 26.7% patients of the control group, in 6.7, 6.7 and 6.7% patients of the study group, respectively. Thus, the addition of a pathogenetic drug indigal plus to sparfloxacin treatment promoted normalization of apoptosis of the infected cells, led to more effective bacterial eradication, enhanced regression of the symptoms. It is recommended to include indigal plus in a basic scheme of treatment of patients with chronic infectious prostatitis.

Effect of different drugs on the level of DNA-hydrolyzing polyclonal IgG antibodies in sera of patients with Hashimoto's thyroiditis and nontoxic nodal goiter.

BACKGROUND: DNA-hydrolyzing IgG antibodies have been detected recently in the sera of patients with several autoimmune diseases. MATERIAL AND METHODS: The relative activity of DNA-hydrolyzing IgG from the sera of patients with Hashimoto's thyroiditis and with non-toxic nodal goiter as a function of the patient's condition were measured. The effect of different drugs on the level of DNA-hydrolyzing IgG, functional activity of thyroid gland, and improvement of clinical condition of two groups of patients were analyzed. RESULTS: We demonstrate here for the first time that IgG from peripheral blood of patients with Hashimoto's thyroiditis (65%) and non-toxic nodal goiter (38%) possesses DNAse activity. The relative level-specific activity of IgGs in hydrolysis of DNA increases with the enhancement of the relative amount of antibodies against thyroglobulin and all patients with hypothyroidism (namely a reduced concentration of thyroxine and triiodothyronine and enhanced level of thyrotropic hormone) are characterized by a high level of catalytic antibodies. CONCLUSIONS: The very widely used therapy of patients with thyroxine led only to a temporary change of the hormone concentration in the blood but did not affect the level of DNA-hydrolyzing antibodies. However, treatment with an immunosuppressive drug plaquenil (7-chloro-4(beta-diethylamine-alpha-methylbutylamie)quinoline), significantly decreased the DNA-hydrolyzing activity of Abs, which correlated with enhancement of thyroid hormone concentrations, elevation of functional activity of the thyroid gland, and improvement of the clinical state of the patients.

RNA-hydrolyzing antibodies from peripheral blood of patients with lupus erythematosus.

Experiments and hydrolysis of substrates with known spatial structures (such as yeast tRNAPhe, as well as normal and mutant tRNALys from human mitochondria produced by transcription of the appropriate DNA species, that is, RNA genes) were performed to study the ribonuclease activity of antibodies isolated from blood sera of patients with systemic lupus erythematosus (SLE). The antibody preparations contained two types of ribonuclease activities: the first corresponded to the specificity of ribonuclease A and was found during hydrolysis at low salt concentrations, whereas the second was stimulated by Mg2+ and displayed unique specificity toward double-stranded regions of the substrate. The possible use of the antibody preparations as tools for structural studies of conformational differences between RNA molecules was examined. In experiments with unmodified and mutant tRNALys species differing in one base found in the T-loop, we found that hydrolysis with SLE antibodies can detect small local structural changes in RNA under physiological conditions.