Method of complex treatment of patients with purulent-necrotic forms of diabetic foot syndrome

FIELD: medicine.

SUBSTANCE: minor amputation of the foot with the further necrectomy is performed. After the application of an antimicrobial bandage and drainage, the wound is hermetised from the environment by the creation of a negative pressure above the wound in a combination with drug treatment. The reatment is performed in two steps. At the first step the wound with the antimicrobial bandage and drainage is first hermetised from above with an adhesive film, with the creation and support of the negative pressure not lower than 80 mm Hg. Urokinase 500000 U is additionally introduced daily intravenously by drop infusion per 100 ml of physiological solution, Vessel-Due-F in a dose of 600 LU per 100 ml of physiological solution and VAP 20 - alprostadil in a dose of 40 mcg per 100 ml of physiological solution. In addition Antistax in capsules is introduced to the patient. At the second stage active 24-hour vacuum aspiration with the change of the negative pressure from 10 to 80 mm Hg within a day is carried out. Additionally introduced is Vessel-Due-F in a dose of 1 capsule with 250 LU 2 times per day between meals and Antistax. At the first and second stages Antistax is introduced in a dose of 2 capsules in the morning 30-40 minutes before meal, daily. Duration of each stage constitutes not less than 7 days.

EFFECT: increase of the treatment efficiency due to the complete and timely purification of the wound from pathological exudates, elimination of the progression of the purulent-necrotic process, increase of the regenerative activity of tissues, activation of local immunity, recovery of microcirculation and oxygenation of the affected tissues.

2 cl, 2 ex

 

Method of complex treatment of patients with purulent-necrotic forms of diabetic foot syndrome relates to medicine and can be used to accelerate the cleansing the wounds, to restore and activate the local immune system and increasing the regenerative activity of the affected tissues.

Known methods of treatment of patients with complicated forms of diabetic foot by the alternating exposure of the extremity of the positive and negative pressure (and.with. The USSR №243787, CL A61M 16/02, 1969) and additional exposure to oxygen with a pressure of 1-2 kg/cm2(and.with. The USSR №946555, CL A61M 16/62, 1982).

This method is designed for the long term treatment and showed insufficient efficiency of treatment of patients with diabetic foot syndrome.

The known method and device for the treatment of ischemia of the lower limbs by exposing the patient centrifugal forces in the direction of the head of the lower limb on a special stand (a.with. The USSR №1674838, CL A61M 1/60, 1991; and.with. The USSR №1245314, CL A61M 16/02, 1986).

In this method, using devices, along with increased arterial inflow, difficult venous outflow, which limits their use in clinical practice, in addition, the equipment involved is very difficult in design, has a high cost and requires about�koivusalo highly qualified personnel.

Known "Method of treatment of patients with obliterating atherosclerosis of lower limb arteries" according to the patent RU 2363499 from 30.01.2007 published 10.08.2009, IPC A61M 1/38 (2006.01), A61N 5/067 (2006.01), A61K 31/5575 (2006.01), A61K 33/14 (2006.01), A61P 9/10 (2006.01), which is carried out by means of blood collection, centrifugation, separation of erythrocyte fractions, removal of plasma and return the red blood cell fraction, wherein the selected fraction is injected amyotrophia medicinal substance in the amount of the average therapeutic dose of 200 ml of erythrocyte fraction, produce irradiation of low-intensity laser radiation of helium-neon laser power of 1.2 mW for 20 min, add in the erythrocyte fraction of 100 ml of saline at 200 ml erythrocyte fraction and return it within 1.5-2 h; as ametropia substance use the drug alprostadil under the trade name of vanaprastha in the amount of 40 µg, dissolved in 5 ml of physiological solution.

This process is complicated, requires the use of laser equipment and does not provide effective treatment due to the lack of adequate drainage of wounds with complicated forms of diabetic foot.

Known "Method of treatment of patients with complicated forms of diabetic foot syndrome" on request EN 2010103097 from 29.01.2010, published on 10.08.2011, IPC A61K 31/00, which implement�represent by drawing blood centrifuge, remove plasma, separation of erythrocyte fractions, the introduction into it of angiotropic medicinal substances, irradiation by laser radiation with a capacity of 12 mW for 20 min, add 100 ml of saline at 200 ml erythrocyte fraction and produce reinfusion for 1.5-2 h, together with amyotrophy substance in the erythrocyte fraction was injected 2 ml of ATP erythrocyte reinfusion fraction produced after 1 day, alternating with intravenous administration of Oars-Doue-f 600 LE intravenously and 5 ml of Actovegin in 100 ml of saline, with a total treatment course of 10 days.

This method also does not provide effective treatment due to the lack of adequate drainage of wounds in complicated forms of diabetic foot complicated for General use in conventional hospitals, because it requires the availability of laser equipment.

Known "Method of treatment of patients with purulent-necrotic lesions of the feet in diabetes mellitus" according to the patent RU 2253427 from 18.12.2003 published 10.06.2005, IPC A61G 10/02, A61K 31/185, A61P 41/00, A61B 17/00, which provide continuous lavage of the foot for several days by placing it in a sealed container with antiseptic, followed by evacuation at a negative pressure of 0.2-0.4 kgf/cm2and the alternation of procedures conducted at intervals of 3-4 h�sa.

This way, with frequent alternation of procedures requires additional time staff and a large consumption of antiseptic, complex in execution, is too cumbersome equipment the lack of effectiveness of treatment due to the lack of a comprehensive approach to treatment.

The closest is the Method of complex surgical treatment of diabetic foot syndrome complicated by purulent necrotic process" according to the patent RU 2405472 from 18.11.2009 published 10.12.2010, IPC A61B 17/00, including opening an abscess or cellulitis of the soft tissues of the foot, revision pockets and purulent streaks, excision of devitalized tissue, debridement of the wound, then the wound is isolated from the external environment with non-flexible container and also the jet is exposed to the proteolytic enzymes trypsin and chymotrypsin, 50 mg of each enzyme, dissolved in 200 ml of 0.9% saline for 1.5 h, then over the wound for 3 h to create a negative pressure of 70-80 mm Hg.PT. with active vacuum aspiration; after an interval of 1 h 1st cycle is repeated, with debridement of 0.06% sodium hypochlorite solution in combination with low-frequency ultrasound is carried out by active aspiration in the same terms.

This method is complicated by the lack of effectiveness of treatment due to Otsu�action of a complex medical treatment, ultrasound equipment and not applicable everywhere in the small hospitals.

The objective of this technical solution is the reduction of terms of treatment and effectiveness of treatment of patients with purulent-necrotic forms of diabetic foot syndrome.

The task is solved by a method of complex treatment of patients with complicated forms of diabetic foot by carrying out minor amputation of the foot with subsequent necrectomy, sealing the wound from the external environment after the application of antimicrobial dressings and drainage, creating over the wound negative pressure in combination with drug treatment, wherein the treatment is carried out in two stages, the first stage of the wound with an antimicrobial dressing and drainage seal the top with duct tape, create and maintain over the wound negative pressure of at least 80 mm Hg.CT., in combination with daily intravenous drip administration of Urokinase 500,000 UNITS per 100 ml of physiological solution, Oars-Doue-f 600 LE 100 ml of saline and 20 GSA - alprostadil 40 mcg per 100 ml of physiological solution and the introduction of Antistax capsules; in the second stage, continue active persistent vacuum aspiration with a change of negative pressure from 10 to 80 mm Hg.PT. during the day, in combination with the introduction of Oars-Doue-f 1 capsule 250 �E 2 times a day between meals and Antistats; thus on the first and second stages Antistax administered 2 capsules in the morning for 30-40 minutes before meals daily; the duration of each stage is not less than 7 days; create over the wound negative pressure and aspirate apparatus Suprasorb SNP P1 (Germany) company Lohmann Rausher International GmbH Co.

The implementation of the method in two stages allows the transition to the second stage to adjust the frequency and scope of change in pressure over the wound, and to clarify the dosage and duration used in the second stage of medicines.

The proposed method of complex treatment of patients with purulent-necrotic forms of diabetic foot syndrome, divided into stages, reduces the time of treatment of patients with purulent-necrotic forms of diabetic foot syndrome, significantly increases the effectiveness of treatment and contributes to a longer preservation of the achieved therapeutic effect due to the acceleration and a more complete cleansing of the wound from the pathological exudate in the complex with increased regenerative activity of the tissues of the foot by suppressing the activity of the causative agent of purulent-necrotic process, the activation of local immunity of the affected tissues, restoration of microcirculation, oxygenation and regeneration of these tissues.

Method of complex treatment of patients with purulent-necrotic forms of the syndrome diabetics�Oh foot is implemented as follows.

The method is carried out in two stages, allowing the transition to the second stage to adjust the frequency and scope of change in pressure over the wound, and to clarify the dosage and duration used in the second stage of medicines.

In the first stage, the wound of the foot as a result of purulent-necrotic complications of diabetic foot syndrome after performing minor amputation and thorough necrotomy stack antimicrobial Kerlix bandage (bandage impregnated polyhexamethylene the biguanides, which is effective against gram-positive and gram-negative microorganisms). If necessary, cut the bandage the wound size. Laid flat wound drain (Soft Drain) at the bottom of the wound on top of the previously laid layer of antimicrobial dressings over the entire length of the wound. On top of the drainage stack one or more layers of antimicrobial Kerlix bandage to the skin level or slightly higher. Seal the wound with adhesive tape. This requires a piece of sticky film of Suprasorb F paste on a bandage with a margin, capturing intact skin. (Film Suprasorb F gas and paranapanema and does not cause chafing of the skin, protects the wound from secondary infection.) For sealing the area of the drainage outlet to the outside put a sticky film of Suprasorb F into two layers of the adhesive layer outside. One layer to the drainage tube, W�Roy layer out. Additionally the seal by compressing bandage fingers film Suprasorb F, round tube drainage. Then completely seal the bandage being branded a loose outer adhesive layer and on the band itself additional piece of sticky film of Suprasorb F overlap. Next, attach the drain tube to the connector Suprasorb CNP P1. And create the necessary negative pressure in the wound to 80 mm Hg.PT, which support around the clock, in combination with medication, Urokinase, Oars-Doue-f, VAP 20 and Antitoxin, within 7 days.

Unlike other techniques, local treatment of the wound by creating a negative pressure apparatus Suprasorb CNP P1 contributes to the full and timely removal of wound exudate, prevents progression of purulent-necrotic process, the further spread of it on foot, the formation of secondary necrosis, in addition, allows the nature and amount of wound exudate to determine the speed and efficiency of a leaking wound healing process and in the transition to the second stage allows to adjust the frequency and scope of change in pressure over the wound, and to clarify the dosage and timing used in the second stage of medicines.

During prolonged local delivery of negative pressure to the wound, firmly decrease vospalitel�-degenerative changes in the wound and the acceleration of regenerative processes after surgical treatment of purulent-necrotic forms of diabetic foot syndrome. There is a persistent transition of wound process in the second phase.

For reducing the local effects of negative pressure on the wound, reduction of terms of treatment, by increasing the efficiency of treatment, the patient is prescribed a complex medical treatment, which simultaneously appoint intravenous Urokinase, Oars-Doue-f, VAP 20 and Antistax capsules.

Urokinase is injected at the first stage, within 7 days, 500,000 UNITS intravenously per 100 ml of physiological solution, daily, which, having fibrinolytic means, is a direct activator of fibrinolysin (plasmin); activates popravivshiesya and disproportionality, turning them into plasmin that causes the enzymatic breakdown of fibrin; lyses the clot from inside and outside; breakdown products of fibrinogen then inhibit the aggregation of platelets and red blood cells, reduce blood viscosity.

Introduction urokinase prevents under the action of heparanase non-clostridial anaerobic bacteria in patients with purulent-necrotic forms of diabetic foot syndrome, pathologic thrombus formation in the microvasculature, reducing blood viscosity.

The first stage simultaneously administered within 7 days of Oars-Doue-f (sulodexide) for 600 LE intravenously in 100 ml of physiological R�of the target, daily with antiplatelet and angioprotective action in the diabetic foot, reduces the thickness of the basal membrane and the production of extracellular matrix by reducing cell proliferation mesangium; mechanism of action is associated angio with restoring structural and functional integrity of vascular endothelial cells, the restoration of the normal density of negative electric charge then the basement membrane of blood vessels.

In the second stage of Oars-Doue-f (sulodexide) appoint 1 capsule (250 LE) 2 times daily between meals.

To reduce the severity of pain and consumption of analgesics at the same time with the other drugs in the first stage, administered for 7 days VAP 20 (alprostadil) 40 mcg intravenously in 100 ml of physiological solution, daily, to improve peripheral circulation and microcirculation, has a vasodilatory effect, enhances the elasticity of red blood cells, reduces platelet aggregation.

For speedy reduction of postoperative edema and normalization of the venous outflow and tone of the venous wall in the comprehensive treatment of the first and second stage included venotonic Antistax, 2 capsules in the morning for 30-40 minutes before meals daily, which are not separately used�is for the treatment of complicated forms of diabetic foot.

For the effective removal of wound exudate and reduce bacterial load, stimulate blood flow, new cell formation and development of granulation tissue, enhance the regeneration of damaged tissues, reducing wound swelling and reduction of the wound size at the second stage of complex treatment of purulent-necrotic forms of diabetic foot syndrome continue active persistent vacuum aspiration apparatus Suprasorb CNP P1 (Germany) company Lohmann Ransher International GmbH Co by changing the negative pressure above the wound from 10 to 80 mm Hg.PT. during the day in conjunction with the acquisition of Oars-Doue-f and Antistax capsules for 7 days; Oars-Doue-f is prescribed 1 capsule (250 LE) 2 times a day between meals; Antistax appoint 2 capsules in the morning for 30-40 minutes before meals, daily. The change of negative pressure over the wound for 10 to 80 mm Hg.PT. during the day, may exercise the patient, reducing every hour at 10 mm Hg.PT.

On the basis of clinical experience, objective research data, the nature and amount of wound exudate, evaluation of subjective symptoms in patients, when using the claimed method of complex treatment of patients with purulent-necrotic forms of diabetic foot syndrome, more rapid relief of pain, reduced feeling heavy�ti, relief of edema, more speedy reduction of the inflammatory type cytograms and a significant decrease of inflammatory and degenerative types of cytograms in the wound, persistent early transition of wound process in the second phase, no need to repeat necrectomy, faster regeneration of injured tissue and epithelialization of the wound, in contrast to the known from the prior art the use of more long-lasting local impact of negative pressure on the wound separately, or applying one or a combination of two or three drugs, but without the local effects of negative pressure on the wound.

The proposed method, excluding daily dressings that reduce labor costs and the costs of dressings may be used in all departments of medical institutions, especially in the offices of purulent surgery.

Clinical examples

Female patient, 61 years was admitted with complaints of pain, swelling, hyperemia of the left foot, the presence of necrosis 2-3-4-5 of the toes. She had non-insulin-dependent diabetes mellitus type 2 for 8 years. Oral hypoglycemic drugs were taken 6 years diabeton MB 1-2 tablets in the morning. The duration from the beginning of the existence of purulent-necrotic complications of diabetic foot to admission - 12 hours. On the day of admission - made amp�maintenance 2-3-4-5 toe with resection of metatarsal bone heads. Further - along with basic drugs (analgesics, antibiotics), he was appointed course Urokinase, sulodexide (Oars-Doue-f), alprostadil (GSA 20) and Antistax capsules, in combination with local treatment of wounds using negative pressure apparatus Suprasorb CNP P1. Treatment with urokinase included the introduction of 500,000 UNITS intravenously per 100 ml of saline daily. Oars-Doue-f was administered on 600 LE intravenously in 100 ml of saline daily. GSA 20 (alprostadil) is injected daily at 40 mg intravenously in 100 ml of physiological solution. Appointed Antistax 2 capsules in the morning for 30-40 minutes before meals, daily. At the same time applied the apparatus Suprasorb CNP P1 to create a negative pressure above the wound, which immediately after the amputation of fingers and resection of metatarsal bone heads conducted a thorough necrectomy and the wound left foot antimicrobial Kerlix bandage. Put flat wound drain (Soft Drain) at the bottom of the wound on top of the previously laid layer of antimicrobial dressings over the entire length of the wound. On top of the drainage put another layer of antimicrobial Kerlix bandage slightly above the skin level. Sealed the wound with adhesive film Suprasorb F. Sealed and thus the area of the drainage outlet to the outside is also a sticky film of Suprasorb F in two layers. Then completely sealed the bandage additionally�m with a piece of sticky film of Suprasorb F overlap. Further attached to a port of the aspirator apparatus Suprasorb SNP P1 and creating pressure to 80 mm Hg.St around the clock. The course of treatment was 7 days. When moving to the second stage of comprehensive treatment of this patient on the nature and amount of wound exudate, continued active persistent vacuum aspiration apparatus Suprasorb CNP PI (Germany) company Lohmann Rausher international GmbH Co, by changing the negative pressure in the wound from 10 to 80 mm Hg.PT. during the day, in conjunction with the acquisition of Oars-Doue-f and Antistax capsules for 7 days; Oars-Doue-f prescribed 1 capsule (250 LE) 2 times a day between meals; Antistax prescribed 2 capsules in the morning for 30-40 minutes before meals, every day.

The results and the efficacy of the treatment was determined by the evaluation of subjective symptoms, the nature and amount of wound exudate and change cytograms before and after treatment. Cytology RAS was performed on 1,7 and 14 days after surgery. Upon completion of the course of treatment according to the method, the pain syndrome was stopped in the foot on day 5, together with a significant decrease in the number of wound significantly decreased the feeling of heaviness in the legs, swelling. Inflammatory type cytograms decreased on day 7. Inflammatory-degenerative type cytograms decreased at 7 days. On the 14th day from the start of treatment was marked regenerative type cytograms. Persistent transition of wound process in the second phase observed on the 7th day from the start of treatment. Repeated necrectomy not required. Bleeding from wounds that would have required any additional treatment measures, with the use of this method of complex treatment of patients with purulent-necrotic forms of diabetic foot syndrome. The lifting apparatus Suprasorb CNP P1 throughout this course of treatment was not required. The patient was discharged on 15th day.

Patient S., 53 years old with a diagnosis of non-insulin-dependent diabetes mellitus type 2 for 10 years was admitted with complaints of marked pain in the foot, pain and swelling, hyperemia 1 and 2 fingers of the right foot, the presence of necrosis 1 and 2 of the toes. Hypoglycemic agents took 5 years maninil 3,5 1 tablet 2 times a day. 20 days ago I had hurt my foot. First treated, treated with iodine. Then I was treated as an outpatient in the clinic during the week - analgesics, ligation with furatsilina, took tsiprolet. As a result of increased pain in the foot, edema, appearance of necrosis 1 and 2 of the toes, sent to the hospital. On the day of admission is made amputation 1 and 2 toe with resection of metatarsal bone heads. It was further held basic therapy - analgesics, Ceftriaxone with Metron�azolam, dressings with water-soluble antiseptics, received therapy according to the program of treatment of patients with complicated forms of diabetic foot. On the 7th day - pain and edema, hyperemia persisted, copious purulent discharge. At 3 and 7 days were conducted twice repeated necrotomy. Predominant inflammatory-degenerative type cytograms. Regenerative type cytograms missing. Decided to change the method of treatment. Prescribed a course of urokinase, sulodexide (Oars-Doue-f), alprostadil (GSA 20) and Antistax capsules, in combination with local treatment of wounds using negative pressure apparatus Suprasorb CNP P1. Treatment with urokinase included 500,000 UNITS intravenously per 100 ml of saline daily. Oars-Doue-f was administered on 600 LE intravenously in 100 ml of saline daily. GSA 20 (alprostadil) was administered daily at 40 mg intravenously in 100 ml of physiological solution. Appointed Antistax 2 capsules in the morning for 30-40 minutes before meals, daily. The course of treatment was 7 days. The second stage of this treatment the patient continued active persistent vacuum aspiration apparatus Suprasorb CNP P1 by changing the negative pressure in the wound from 10 to 80 mm Hg.PT. during the day in conjunction with the acquisition of Oars-Doue-f and Antistax capsules for 7 days; Oars-Doue-f was administered �about 1 capsule (250 LE) 2 times a day between meals; Antistax prescribed 2 capsules in the morning for 30-40 minutes before meals, every day.

As a result of this method of complex treatment of pain syndrome was stopped in the foot on day 5, significantly decreased the feeling of heaviness in the legs, swelling. Inflammatory type cytograms decreased on day 7. Inflammatory-degenerative type cytograms decreased on day 7. On the 14th day from the beginning of complex treatment was noted regenerative type cytograms. Persistent transition of wound process in the second phase, the nature and amount of wound exudate, marked already on the 7th day from the start of treatment. Additional necrectomy was not. Bleeding from a wound on the background of the application of the method of complex treatment of patients with purulent-necrotic forms of diabetic foot syndrome was not. The lifting apparatus Suprasorb CNP P1 throughout this course of treatment was not required. The patient was discharged on day 21.

Sources of information

1. Aut. SVID. The USSR №243787, CL A61M 16/02, 1969.

2. Aut. SVID. The USSR №946555, CL A61M 16/62, 1982.

3. Therapeutic physical training in the system of medical rehabilitation. A guide for physicians. Edited by A. F. Kapteina, I. P. Lebedeva. M., 1955.

4. Aut. SVID. The USSR №1674838, CL A61M 1/60, 1991.

5. Aut. SVID. The USSR №1245314, CL A61M 16/02, 1986.

6. Patent RU 2363499 from 30.01.2007 published 10.08.2009, IPC A61M 1/38 (2006.01), A61N 5/067 (2006.01), A6K 31/5575 (2006.01), A61K 33/14 (2006.01), A61P 9/10 (2006.01).

7. P. A. Vorobyov. Intermittent treatment plasmapheresis. Moscow, 1998, pp. 18-24.

8. Application RU 2010103097 from 29.01.2010, published on 10.08.2011, IPC A61K 31/00.

9. The patent for invention RU №2363499 C2 from 10.08.2009.

10. Patent RU 2253427 from 18.12.2003 published 10.06.2005, IPC A61G 10/02, A61K 31/185, A61P 41/00, A61B 17/00.

11. Patent RU 2405472 from 18.11.2009 published 10.12.2010, IPC A61B 17/00.

12. Register of medicines of Russia. "Radar-21st edition". Moscow 2012. Wyskowski G. L.

1. Method of complex treatment of patients with complicated forms of diabetic foot, including carrying out minor amputation of the foot with subsequent necrectomy, sealing the wound from the external environment after the application of antimicrobial dressings and drainage, creating over the wound negative pressure in combination with drug treatment, wherein the treatment is carried out in two stages, the first stage of the wound with an antimicrobial dressing and drainage seal the top with duct tape, create and maintain over the wound negative pressure of at least 80 mm Hg.CT., in combination with daily intravenous drip administration of Urokinase 500,000 UNITS per 100 ml of physiological solution, Oars-Doue-f 600 LE 100 ml of saline and 20 GSA - alprostadil 40 mcg per 100 ml of physiological solution and the introduction of Antistax capsules; in the second stage, continue active persistent vacuum-aspir�tion with the change of the negative pressure from 10 to 80 mm Hg.PT. during the day, in combination with the introduction of Oars-Doue-f 1 capsule 250 LES 2 times a day between meals and Antistats; wherein the first and second stages Antistax administered 2 capsules in the morning for 30-40 minutes before meals daily; the duration of each stage is not less than 7 days.

2. A method according to claim 1, characterized in that pose over the wound negative pressure and aspirate apparatus Suprasorb SNP P1 (Germany) company Lohmann Rausher international GmbH Co.



 

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FIELD: medicine.

SUBSTANCE: method involves creating the conditions for improving pancreatic outflow by an external drainage of a major pancreatic duct. That is combined with intraductal administration of Ondansetronum, 5HT3 receptor antagonist in an amount of 2 ml, a dose of 4 ml through an inserted nasopancreatic drain tube.

EFFECT: lower rate of acute postoperative pancreatitis, total number of complications, reducing the length of treatment by the targeted action on active valves of the pancreatic duct system, providing the adequate drainage thereof and eliminating the conditions for duct hypertension.

1 ex

FIELD: medicine.

SUBSTANCE: biological fluid aspirate is taken from the anterior nasal cavity by placing a 7-8 mm stopper on a soft catheter by means of a mm-ruler. Air 1 ml is taken into a syringe; the catheter is inserted into the anterior nasal cavity at 7-8 mm, and the biological fluid is taken. The catheter is removed, and the biological fluid with the air is ejected from the syringe into test tube No.1. The catheter is washed with 0.85% sodium chloride 5 ml. That is followed by placing a 20 mm stopper on the soft catheter, and the air 1 ml is taken into the syringe, and the catheter is inserted into the deep nasal pharynx at 20 mm. The biological fluid is taken; the catheter is removed, and the biological fluid with the air is ejected into test tube No.2. The concentration of average-molecular peptides (AMP) is measured in test tubes No.1, No.2. If the AMP difference in test tubes No.1 and No.2 makes 0.009±0.001 absorbance units, the mature newborn infant is considered to be healthy. If the AMP difference in test tubes No.1 and No.2 makes 0.018±0.001 absorbance units, respiratory distress syndrome is diagnosed in the newborn infant.

EFFECT: technique provides the most effective diagnosing of the given pathology in the mature newborn infants, including in the meconium-contaminated amniotic fluid aspiration.

4 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: group of inventions relates to medical equipment, includes a medical connector (versions) and a method of the connector exploitation, and is intended for supply of a liquid by means of the medical connector, which has a low volume of filling and a low direct displacement when disconnected. The connector contains a valve case, a valve plug, a membrane and a valve insert. The valve case is provided with an input branch piece, an output branch piece, an internal wall and one or several channels in the internal wall, which form a current line from the input branch piece to the output branch piece. The valve plug is intended for sealing the input branch piece when the connector is in an inactive state and closes the line of current through the connector. The membrane is placed in the valve case. The valve insert is located in the valve case and contains a cup, sealed with the membrane with formation of an internal volume. The valve insert contains a rod, extending into the output branch piece and configured in such a way that a transverse section of the output branch piece flow is equivalent to the transverse section of the current line flow, formed by one or several channels in the internal wall of the valve case. When the connector is put in action, the valve plug deforms the membrane into the internal volume, and unseals the input branch piece and opens the line of current through the connector.

EFFECT: inventions make it possible to provide characteristics of a direct liquid displacement after putting in action the connector, which has the low volume of filling due to construction of the valve plug, the valve insert and the membrane.

22 cl, 6 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to urology and balneology, and can be used as rehabilitating treatment of nonspecific diseases of male genital organs. For this purpose disposable injection 200-250 g syringe with tip for catheter nozzle, is filled with mud from disposable pack Doy Pack with doser, filled with homogenised silt sulfide mud. Disposable urologic 140 mm long catheter, with 7 mm diameter, made from plastic with smooth surface polymer with rounded edges is put onto syringe tip. After that, catheter is introduced into patient's rectum. Mud temperature in 1-2 procedure constitutes 38-40°C, in the following procedures - 40-42°C. Duration of procedure is 35-40 minutes. Procedures are carried out daily, 5 times per week, course includes 14-16 procedures.

EFFECT: method makes it possible to ensure expressed therapeutic action with simultaneous comfort and aesthetics of procedure due to accurate dosing and increase of time medicinal mud impact, conditioned by selected temperature of impact.

2 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and can be used for treating trophic ulcers and purulonecrotic involvements of lower extremities in diabetic patients. That requires a baseline therapy and a regional fibrinolytic therapy. Conducting the regional fibrinolytic therapy following applying a rubber bandage on the lower one-third of the shin is accompanied by administering Urokinase medac in a dose of 100 thousand units into the heel bone once a day within 5 days.

EFFECT: in the setting of reducing the total dosage of the preparation, the invention enables providing the high concentration of Urokinase medac in a pathological centre, improving microcirculation and metabolic processes in the involved tissues, accelerating the wound healing and reducing the length of hospital admission of the patients suffering from diabetic foot syndrome.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery. A polyethylene tube is inserted into a mesentery. A solution containing proserine in a dose of up to 50 mg is introduced through the inserted tube. A synovial fluid 2 ml dissolved in normal saline 10 ml is additionally administered along the enteroenteroanastomosis.

EFFECT: method provides preventing peritoneal adhesions following the abdominal surgical operation by administering the preparations promoting better peristalsis and slide of the intestinal loop in the abdominal cavity.

1 tbl

FIELD: medicine.

SUBSTANCE: treating retinal and/or vitreous hemorrhages is ensured by a session of subcutaneous administration of Histochrom 0.5 ml into a mastoid bone, Echinacea compositum 1.0 ml into a temporal fossa, Gemase 2500-5000 IU parabulbary dissolved in Lymphomyosot 0.5-1.0 ml. The therapeutic course is 10-15 sessions, either daily or every second day.

EFFECT: faster resolution of the intraocular hemorrhages, prevention of retinal injuries by toxic decay products, higher visual acuity.

3 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to therapy and pulmonology, and can be used for selection of tactics of treating thromboembolism of pulmonary artery. For this purpose computered tomography with bolus enhancement is performed to patient, areas of affection located more distally than thrombotic embolus are examined and number of respiratory movements per minute is taken into account. Presence of occluded vessel or vessels in examined areas is identified. Occlusion of segmental branch of pulmonary artery, located more distally than embolus, is assessed in one point irrespective of degree of vessel occlusion. Occlusion of each of lobar branches in case of affection of right middle lobar, left middle- and upper lobar branches of pulmonary artery is assessed in 2 points. Occlusion of upper lobar branch of pulmonary artery on the right, lower lobar branch of pulmonary artery on the left is assessed in 3 points. Occlusion of right lower lobar branch of pulmonary artery is assessed in 4 points. Occlusion of left main pulmonary artery is assessed in 7 points. Occlusion of right main pulmonary artery is assessed in 9 points. Occlusion of both main pulmonary arteries and/or pulmonary trunk is assessed in 17 points. After that, points are summed up. If the sum of points is from 1 to 6, anticoagulation therapy is performed with heparin. If the sum of points constitutes from 7 to 10 at rate of respiratory movements (RRM) lower than 18, another anticoagulation therapy is performed, at RRM more than 18 - thrombolytic therapy is performed. If the sum of points constitutes from 11 to 17, thrombolytic therapy is performed.

EFFECT: method provides possibility of operative objective assessment of degree of pulmonary bed affection and beginning of required therapy in due time.

5 dwg, 1 tbl, 4 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely cardiology and concerns treating the patients with ST segment elevation acute myocardial infarction. That is ensured by the two-bolus intravenous administration of the thrombolytic preparation Fortelysine in a dose of 10 mg, and 30 minutes later in a dose of 5 mg.

EFFECT: presented mode of administration of Fortelysine provides the effective recovery of the antegrade coronary blood flow in the infarction-involved coronary artery in the patients with ST segment elevation acute myocardial infarction.

1 ex

FIELD: medicine.

SUBSTANCE: treatment involves the paracervical introduction of a mixture containing klaforan 2 g, hemase 5000 units, 0.5% novocaine 20.0 ml, prednisolone 50.0 mg. The mixture is introduced once a day for 10 days.

EFFECT: effective treatment followed by recovery of hormonal and ovulatory ovarian function.

3 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology, and deals with treatment of hemorrhages which occur, for instance, at the background of age-related macular degeneration with subretinal neovascularisation. For this purpose courses of treatment are carried out in sessions, each of courses includes carrying out mydriasis of affected eye, puncture of sclera to vitreous body and alternate introduction of medications. At the first session introduced is medication which inhibits factor of vessel growth (MIFVG), fibrinolytic medication (FM) and medication of expanding gas (MEG), for instance, sulfur hexafluoride. At the second session, in case of hemorrhage, the same medications are introduced. If there is no hemorrhage at the second and following sessions only MIFVG is introduced. Simultaneously with puncture of sclera paracentesis of cornea is performed through which drainage of moisture, normalising intraocular pressure, is carried out. MIFVG dose is calculated depending on degree of retina edema, FM and MEG doses are selected proportionally to hemorrhage value determined during fundus examination. Single MEG dose constitutes 0.05-0.35 ml. After sessions, at which MEG is introduced for 1-1.5 weeks control over resolution process is performed and it is recommended to patient to preserve "face down" head position until gas is resolved completely. 10-15 seconds after introduction of all included into particular treatment session medications, needle is removed, interval between sessions is selected equal from 3 weeks to 1.5 months.

EFFECT: method increases treatment quality due to elaboration of specific regimen of impact of said treatment methods, which ensures not only elimination of hemorrhage but also leads to elimination of it causes with minimisation of traumatic factors of treatment.

3 ex

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