The method of treatment of rheumatoid arthritis

 

(57) Abstract:

The invention relates to rheumatology and is intended for the treatment of rheumatoid arthritis. Carry out individually selected, contact the radiation at the same time of all involved in the inflammatory process in joints and periarticular structures using infrared pulsed laser radiation. The power density for each pain point is 0,056 mW/cm2at a frequency of 80 Hz or 0,87 mW/cm2at a frequency of 1200 Hz. The total power per session varies from 0.5 to 6.0 j. Exposure point 1-4 minutes Method can improve the effectiveness of treatment and the duration of remission, to avoid frequency of injection in the joint or periarticular structures of corticosteroids due to the correct choice of parameters of radiation, the current methods of irradiation energy dose in General. table 1.

The present invention relates to rheumatology and is intended for the treatment of rheumatoid arthritis.

Pathogenetic mechanisms of rheumatoid arthritis (RA) associated with severe disturbance of cellular and humoral immune responses. Pathological activation of the immune system in RA is characterized by an imbalance midnig adhesion molecules (KMA), what is the main factor for chronicity and progression of joint inflammation, leading to pannus formation and destruction of cartilage and bone of the joint. In the first 3-5 years of the disease become disabled to 60% of patients.

In recent years, along with the development of new pharmacological approaches and schemes for the treatment of RA, considerable attention is paid to the improvement of methods of non-pharmacological therapy, especially laser therapy, but the possibility of using laser radiation in the middle infrared spectrum devoted to a relatively small number of studies with conflicting results efficiency. Pathogenetic substantiation of the mechanisms of action of laser irradiation developed is clearly not enough. Infrared laser therapy because of its deep permeability (for a wavelength of 0.82-0.89 µm penetration depth of the radiation is 3-7 cm) and athermal effects (at the level of organs) is one of the promising methods of non-pharmacological treatment of RA today. The reasons for the contradictory results obtained by different authors, are numerous, but are most often associated with lack of differentiations of the effect of the selected wavelength, flux density monoadducts, on biologically active points, and so on) that determines the energy dose in General, which also depends on the effect of laser therapy. Besides the effect depends on the activity, stage, features of the disease and individual patient characteristics, and given the possibility of photoresistance (3 to 5% of cases). One of the features of joint pathology is overlapping laser emitter. Ignoring the above can only discredit this method. Border energy oblojennosti providing biostimulating effect, are in the range of 0.3-100 mW/cm2that also complicates the comparability of results.

There is a method of treatment of juvenile rheumatoid arthritis by contact exposure to pulsed electromagnetic radiation of a wavelength of 0.89-0.95 μm to certain corporeal biologically active points (patent RU 2072825, 10.12.97). The method allows to reduce the main manifestations of the disease due to the impact on the autonomic and immune systems and improve regeneration and trophism.

There is a method of treatment of patients with rheumatoid arthritis by affecting the laser pulse radiation at t reduces the main manifestations of the disease in a short time, provides increased remission period.

There is a method of treating diseases of the musculoskeletal system by contact exposure area of the joint pulsed infrared laser radiation with a wavelength of 0.8-0.9 μm, the pulse frequency 1500-3000 Hz, pulse power 8-10 watts each laser emitter matrix of the 10 built-in laser emitters size: 12 cm2, i.e., 80-100 watts on each field. While implementing synchronization intensity laser irradiation with the rhythms of respiration and circulation, irradiating two large joints not more than 10 fields, for 128-256 with on point and 1200 s for the procedure. Irradiation is carried out in the projection of the joint space and in the area of the painful points of the joint (patent RU 2104070, 10.02.98). This method adopted by us for the nearest equivalent. However, this method is not specified dosage to the point of pain, and for the whole procedure. Not the expediency of use 10 laser emitters on the area of projection of the joint space, when one emitter is also possible to cover the affected area and 10 times to reduce the energy dose. The five points are appropriate only for the treatment of the knee joint, but not for other large articular joints. Not specified the principle of selecting a frequency of 1500 Hz or 3000 Hz and duration of exposure. With the involvement of several groups of joints are available sequential irradiation and long-term rate of 35 procedures. The technical result of the proposed method is to accelerate the reduction of inflammation in the joint.

The technical result of the proposed method is achieved due to the impact of selected parameters of laser radiation on the functional status and the inflammatory process through influence, in particular, markers of activation of cellular immunity RIL-2P, RFE-P, neopterin and other

Progress in the study of the immunopathology of RA is largely associated with the discovery of soluble cytokine receptors (soluble tumor necrosis factor receptor - HNO-R, soluble interleukin 2 receptor - RIL-2P) and soluble isoforms KMA (rkma), such as P-selectin, and neopterin concentrations (sensitive and specific marker of activation of monocytes/macrophages) and the development of methods for their determination in biological fluids. However, the results concerning the clinical significance of the determination of the Rila-2P, RFE-P, P-selectin and neopterin concentrations in RA to assess the clinical characteristics of the disease, the activity of the P CLASS="ptx2">

The analysis of the level of technology and obtained preliminary data allowed us to stay on nadstavkoj method IR pulsed laser radiation as the most effective methods for its improvement and comparison with the placebo group. Our research has demonstrated the importance it nadstavna method of exposure and effect relationship with a local impact on joint and/or periarticular structures. The basis of the impact the proposed method was based on the principle of using small doses of infrared pulsed laser radiation, the possibility of simultaneous impact on all joints involved at the moment in the inflammatory process, as well as the impact on periarticular structures. In addition, for dose adjustment in the process of treatment in an individual patient used index data Richie, which was modified so that included an assessment of involvement of periarthritis for each joint.

The method is as follows.

Laser therapy is carried out on the contact nadstavkoj method in the projection of joint gaps and the tendon attachment at the periarthritis with one laser emitter at a wavelength of 0.8 to 0.9 μm and maxdigitall picked up depending on the severity of pain sensitivity. The dose range for the procedure individually picked up, he was from 0.5 to 6.0 j. The power density at a point 0.056 mW/cm2at a frequency of 80 Hz and 0.86 mW/cm2at a frequency of 1200 Hz. Energy irradiance at a point in 1 minute was 3,36 MJ/cm2and/or of 50.4 MJ/cm2. The dose was adjusted during the course readings modified index Richie, i.e. progressively reduced. Laser therapy, patients received daily, 10 procedures for the course. Repeated courses of treatment by laser radiation conducted through two to three months taking into account the duration of recurrence-free period in each particular patient. Just over a year the patient received 3 courses. Monitoring of patients was carried out during the year.

In the course of treatment was observed adverse reactions, and especially no exacerbation of the underlying disease.

The effectiveness of the proposed method for the treatment of rheumatoid artiritis (even in the acute phase), evidently connected with the peculiarities of the selected radiation parameters, namely with lower radiation doses, and at the same time, with exposure to a large number of painful joints and periarticular points. Analgesic effect was achieved immediately after the procedure and continued on protino, during the period of rest of the cells have a small charge of -70 mV between the inner and outer membranes. Upon receipt of the pain signal is depolarization of the cell membrane, raising the potential of up to +30 mV, which is sufficient to activate the synthesis of neurotransmitters. The use of pulsed electromagnetic fields, including laser therapy, leads to a decrease of the resting potential in the synaptic membrane to hyperpolarizing level (-90 mV). Therefore, the force of the pain signal that reaches approximately +10 mV, is insufficient, which causes it to block. This mechanism to a certain extent, help to explain the immediate analgesic effect, set in our way, immediately after completing the procedure of laser radiation.

Just spent 152 courses of laser therapy on the proposed method, 25 courses were false treatments. Conducted statistical processing of data obtained in 38 patients (26 in the main and 12 in the control group), all female with reliable diagnosis of RA according to the ACR. In 26 of them (25 seropositive, 1 seronegative), received 2 courses of laser therapy on the proposed method. In 21 patients conducted three courses. In the control grast main group averaged 48.510.4 years; disease duration 11,49,6 years. In the control group the average age of patients was 47.29 3 years, and disease duration 10.88,9 years old. X-ray phase classification Steinbrocker 2 patients was I, 3 - II, 15 - III, 6 - IV in the main group and 5 patients - II, 3 - III 4 - IV in the control group. Rheumatoid nodules were detected in 13 patients of the main group and 4 control, polyneuropathy 4 and 2. Aseptic necrosis (5 patients) and Sjogren syndrome 1 occurred only in patients of the main group. 35 patients were seropositive for rheumatoid factor (RF). In the control group 47.16 and 10.8, respectively. X-ray phase on Steinbrocker 2 patients was I, 3 - II, 15 - III, 6 - IV. The interval between I and II at an average rate was 5.3 months, between II and III is 6.2 months.

Analysis of clinical parameters before and after courses of laser therapy on the proposed method in comparison with the treatments showed a statistically significant reduction of the modified index Richie, in which in addition to the conventional indicators was included assessment palpation tenderness of the tendon attachment (periarthritis), duration of morning stiffness, the circumference of the interphalangeal joints of the right and left hands, which brushes, compared to false treatments (table 1). Functional status of patients, estimated using test Whether and Stanford questionnaire after each course statistically significantly improved compared with the control group (z = 2.17, p < 0.05) and before 3 course, compared with the values of the relevant indicators before 1 year (z = 2.15, p < 0,05). In addition, the analysis of the studied parameters in comparison before 1 and 3 courses statistically significant decrease in morning stiffness and reliable increase the force of contraction of the left hand. Indicating a prolonged effect.

Thus, studies have shown that laser therapy on the proposed method in our chosen mode has a clear analgesic and anti-inflammatory effect. In laboratory indicators ESR, CRP and plasma viscosity statistically significantly decreased after 1-St and 2-nd course of laser therapy and, after reaching a certain level plateau after the 3rd course, were not statistically significant changes. After placebo treatment, these parameters increased, not reaching statistical significance. Between them revealed a positive correlation. Was determined and superoxide 1 to 0,230,21 t=2.33, p < 0.05, z=2,50, p, 0.05), whereas in the placebo group were significantly changed (t=1.23, p > 0.05) at the rate 0,390,079 mm/106-min. Production of peroxynitrite in the placebo group was not statistically significantly changed. Amid a two-week course of therapy products peroxynitrite statistically Vysocanska decreased (z=3.003, p < 0.01) to the level of norms (39,1227,698 on 17,7511,47 the norm 28,045,70 nM/106tile/min).

Superoxiddismutase in this group (n=18) was lower than normal and after a course has significantly increased (from 0,3150,34 to 0,4870,59 z=2.15, p < 0.05), whereas in the placebo group did not change.

Level transparentvaginal iron in the serum of 20 patients was significantly increased (16.215.65 to 21.346.15, z=3.88, p < 0.01), whereas in the placebo group significantly decreased (from 19.988.55 to 17.345.47, z=2.07, p < 0.05).

Level investigated soluble TNF-alpha receptor in patients with RA on a background of treatment significantly decreased after therapy z=2.87, p < 0.05. The level of P-selectin in the same group was within the normal range and did not change significantly (320,26168,75 on 240,53109,83, z=2.136, p < 0,05). The level of the CEC statistically significantly decreased. Serum neopterin in the dynamics examined in 46 patients. In 21 patients after 1 year of therapy neopterin with 8,95+of 2.51 decreased to 8,161,. the 11 patients within 3 course 9,622,54 decreased to normal values 8,702,96.

A study using laser-dopplerflowmetry showed in the dynamics after each rate increase in the level of normal basal blood flow. Catamnestic confirmed 2-3-month preservation duration of therapeutic effect. Although treatments of laser therapy was performed in patients with high clinical and laboratory activity, exacerbation of the underlying disease and the side effects were not observed.

The method is illustrated by the following clinical examples.

Example 1. Patient K., born in 1947. Diagnosis: Rheumatoid arthritis seropositive arthritis with systemic manifestations (rheumatoid nodules), stage 3, act 2, TN 2. born in 1947. Ache from rheumatoid arthritis since 1981. Hospitalized in the Institute of rheumatology with 16.03.96 on 14.04.96, and b/W. 930/96. Receives basic therapy: methotrexate in 1992, at the moment, 7.5 mg per week, Arson 2 times in 20 mg. the Patient was admitted to our Department with complaints of pain in jaw when opening mouth and in the process of chewing, both sternoclavicular joints, shoulder, elbow, arm-wrist, small joints of the hands, left hip, both knee and ankle joints. Autoceste effect of drug therapy mounted laser on the proposed method in two weeks.

Status praesens: palpation tenderness of the right temporomandibular joint (mouth does not open fully), both sternoclavicular joint with palpation tenderness. Periarthritis of both shoulder joints. Chronic arthritis of both elbow joints with pain with movement and palpation and contractures. Right flexion/extension 150o/20oleft 145o/40o. Bilateral synovitis of the wrist joints. Symmetrical synovitis of the proximal interphalangeal joints of both hands by palpation is painful. The compression force is reduced from two sides. Suprapatellar synovitis of the right knee joint pain when moving in both knee joints. The volume of traffic in the limited 120o/0o. Arthritis in both ankles. Pain on palpation of both the 1st metatarsophalangeal joints. Subcutaneous rheumatoid node in region 1 metatarsophalangeal joint.

Clinical observation: a modified index Richie before the treatment by the proposed method was 75 points, after - 11; morning stiffness: before therapy lasted for 3 hours, after 20 minutes; the compression force of the right hand to therapy 36 mm RT.art., after therapy had increased to 41,33 mm RT.art., left hand 28,66 and 41,33, respectively.donkey therapy decreased to 245. Pain was assessed using visual analogue scales: at rest and during movement, where 0 represented the state of no pain and 100 mm - maximum pain. Thus, YOUR alone to laser therapy pain evaluated in 39 mm, after laser - 23 mm. in YOUR movement to laser 40 mm, after - 21 mm Functional status of patients evaluated in two ways - using the Stanford questionnaire assessment of health and functional test. On the first test with 1,625 index improved to 0.75, functional test WHETHER from 17 to 5. Increased flexion in the area of the right knee on the 20omarked improvement in flexion contractures in each of both elbow joints 10o.

In laboratory tests: ESR decreased from 44 to 29 mm/h, CRH from 3 to 1.9 mg/%, CEC from 510 to 340, seromucoid from 0,52 to 0.46 units of the Russian Federation has not changed 1/1280, factor necrose tumors (TNF)-alpha with 2,11 to normal 0,69 pilgr/ml (normal up to 1,420 pilgr/ml), P-selectin was and remained within normal limits (normal 229,93 oil and gas fields oil and gas fields./ml). Neopterin was 10.8, was 4.6 nmol/l (at a rate of 8.7 nmol/l).

Analysis of thermography after the laser over the treatment of joint dynamics of indicators assessed as positive. On ultrasound the thickness of the synovial membrane in the left knee sousta the VA found cysts Becker. Right cyst size 72 x 28 x 16 mm decreased to 70 x 22 x 13 mm, left the cyst was the size of 53 x 6 x 4 mm and after therapy was not detected. According to the study of microcirculation using laser-dopplerflowmetry marked increase initially reduced basal blood flow in the forearm, reducing vasodilation especially over the left knee joint (normalization of tone venules).

At the beginning of treatment, the modified index Richie was 75 points after 11. Palpation painful to therapy was 14 joints on both sides. After the laser 4 and 6 joints, respectively. As periarthritis, number of joints corresponded to the number of irradiated fields. The energy dose per procedure was 1160,8 MJ, and for the last 269,5 MJ.

Given these clinical, laboratory and instrumental studies, we can conclude that in this patient the laser had as analgesic and anti-inflammatory effect, significantly reduced morning stiffness, improved functional activity.

Example 2. Patient I., 1937 birth. Diagnosis: Rheumatoid arthritis seropositive polyarthritis, stage 3, act 2, FN 1. Secondary generalpopulation at the Institute of rheumatology with 6.04.98 on 29.04.98, and b/W. 1655 s/98. Of drug therapy gets: Plaquenil - 11.1995, 400 mg / day and Voltaren 150 mg per day, alpha D3, 3 caps. in the day since 1997. For 1997 and 1998 made 14 in/s podolov with corticosteroids. The patient was admitted to our Department complaining of severe pains in almost all groups of joints, morning stiffness for 3 hours and the fever since March 1998.

In clinical status: Pain, limited mobility of the cervical spine, slight swelling of the left sternoclavicular joint with palpation tenderness. Periarthritis of both shoulder joints, XP. arthritis of both the elbow and wrist joints (more left) with signs of bilateral styleedit. Pain on palpation of almost all bestoflongbeach joints with synovitis 2, 3, 4 joints of the left and 1, 2, 3 bestoflongbeach joints of the right hand. Synovitis of the proximal interphalangeal joints 3 and 4 left and 2 and 3 right hand. The compression force is reduced from two sides. Palpation bolezney also almost all of the proximal interphalangeal joints. Chronic arthritis in both hip joints with pain with movement and palpation sensitivity of both large skewers. Synovitis of the left knee is userlanguage joints. In addition to fever other signs of systemic manifestations were found. Due to the lack of effect of drug therapy mounted laser on the above described way for two weeks.

The modified index Richie before therapy was 87 points after 10, morning stiffness: to laser lasted 2 hours, after 30 minutes, the compression force of the right hand: before therapy - 16.6 mm RT. Art. after therapy was increased to 20 mm RT. senior, left hand: 18 and 24.6, respectively. The circumference of the interphalangeal joints of the right hand to therapy was 257.5 after therapy 251.5, left hand: before therapy of 247.5, after therapy was reduced to 240. Pain was assessed using visual analogue scales (VAS) pain at rest and with movement, with 0 mm represented the state of no pain and 100 mm - maximum pain. Thus, YOUR alone to laser pain is estimated at 45 mm, after laser - 0 mm when YOUR movement to laser 55 mm after 30 mm. Functional status of patients evaluated in two ways: using the Stanford questionnaire assessment of health and functional test. On the first test with 1.0 index fell to 0.875, functional test WHETHER from 6 to 4. Before therapy in the left knee joint was synovitis with effusion. 07.05.98 was makuhita synovial fluid for analysis in an amount of 5 ml and again introduced 2 ml of 2% Xylocaine. Biochemical analysis of synovial fluid showed a significant reduction in signs of inflammation after laser therapy, observed: reduction of lymphocytosis with h to h, the percentage of phagocytes decreased from 25% to 11%. In synoviocytes: granulocytes decreased from 42 to 20, lymphocytes increased from 47 to 69, the number of monocytes 10 is not changed, and the number of synoviocyte - 1. Draws attention to the fact that effusion in the knee joints not had anticipated during the year. After a course of therapy the patient felt much better for 3 months, when he was made a second course of therapy.

In laboratory tests: ESR decreased from 37 to 19 mm/h, CRH from 4.6 to 2 mg/%, CEC and has not changed: to 230 after 230, seromucoid from 0.7 to 0.43 units of the Russian Federation has not changed 1/80, factor necrose tumors (TNF)-alpha with up to 2.488 1.727 pilgr/ml (normal up to 1,420 pilgr/ml), P-selectin was 316.4 decreased to the normal range 141.4 (norm 229,93 oil and gas fields./ml).

Analysis of thermography after the laser over the treatment of joint dynamics of indicators assessed as positive. On ultrasound the thickness of the synovial membrane in the left knee joint with 4.2 mm decreased to 3.7 mm after laser in right from 3.2 to 3.0 mm (at a rate of 2-3 mm). According to the study microcirkulatornogo the particular forearms and lower initial elevated basal blood flow above the knee joints more to the right. At the beginning of treatment: modified index Richie was 87 points after 10. Palpation painful to therapy was 17 joints on the left side and 16 on the right, after therapy 0 and 5 joints. The laser beam was irradiated 21 fields left and 20 right. Upon completion of the course remained two fields by palpation painful on the left side (periarthritis: type styleedit the radial bone and pertrochanteric) and 8 on the right (periarthritis of the shoulder joint, steroidic, palpation tenderness of the wrist joint, pain on palpation, 2,3,4 bestoflongbeach joints, pertrochanteric and pain on palpation of the 1st metatarsophalangeal joint). Energy intake during the first procedure was 4988,7 MJ, and for the last 1960,5 MJ.

Example 3. Sick So Diagnosis: Rheumatoid arthritis seropositive polyarthritis, stage 3, act 2, FN 1. Ache from rheumatoid arthritis since 1993. Observed in the Institute of rheumatology 1994. Since then receives Plaquenil 400 mg per day and Voltaren 150 mg per day. Hospitalized in the Institute of rheumatology with 14.10.97 on 19.11.97, and/b 2335/97, with complaints of pain in the shoulder, elbow wrist and ankle joints. Less pronounced pain in the cervical spine and small joints of the hands. Morning first received placeblogs treatments of laser therapy.

In clinical status: Arthritis and periarthritis of both the elbow, wrist and ankle joints, especially the left. Not expressed periarthritis of the long head of the biceps of both shoulder joints. Small limited lateroflexion cervical spine, accompanied by pain. Lymphadenopathy left armpit. The modified index Richie before therapy was 38 points, after - 56, morning stiffness: to laser lasted 30 minutes, after 3 hours, the compression force of the right hand: before therapy - 45,3 mm RT.article after treatment decreased to 35 mm RT.art., left hand 56,0 and 48.3, respectively. YOUR pain alone until laser is estimated at 25 mm, after laser level of pain has not changed - 25 mm YOUR pain when moving to laser 45 mm, after placebo therapy increased to 65 mm Functional status of patients assessed using the Stanford questionnaires assessing health deteriorated after therapy - index increased from 0,875 1.25. According to the functional test WHETHER the index fell 9 to 7.1.

In laboratory tests: ESR to therapy 20 mm/hour, after 22 mm/h, CRH to 2.5 mg/%, after 4.5 mg/%, CEC, 300, after 310, seromucoid from 0.52 to and 0.43 units after therapy with a subsequent increase to 0.8, RF 1/20, and after 1/80. In protein fractions albumin reduced the governmental joint dynamics of termoizlotsaiya assessed as negative. MRI of the joints (shoulders, knees, hip joints) were observed dynamics.

As in the main group, laser therapy was carried out above all by palpation painful joints, for 10 days, but the power output was 0 watts. After this course, not only the pain intensified, but also involved new 10 joints that were not painful in the beginning of the study. In General, this case can be described as the deterioration in the background of placebo treatments. Assigned to infiltration by Diprospan in the left ankle.

Thus, the proposed method infrared pulsed laser therapy is a valuable additional method for the treatment of rheumatoid arthritis, the effectiveness of which depends on the correct choice of parameters of radiation, ongoing treatment and energy doses in General.

The method of treatment of rheumatoid arthritis, including contact exposure area of the joint pulsed infrared laser radiation with a wavelength of 0.8 to 0.9 μm, characterized in that it further affect periarticular pain point simultaneously with the irradiation of all involved in the inflammatory process of the joints, while ispolzuu total power per session from 0.5 j to 6 j with exposure time 1 - 4 min to the point of pain, and the exposure parameters change in accordance with changes of the modified index Richie.

 

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1 ex

FIELD: medicine.

SUBSTANCE: method involves intravitreously introducing two electrodes into intraocular neoplasm after carrying out vitrectomy and retinotomy to expose the intraocular neoplasm. The electrodes are manufactured from platinum group metal. Electrochemical destruction is carried out with current intensity of 100 mA during 1-10 min or 10 mA during 10 min in changing electrodes polarity and their position in the intraocular neoplasm space, and the electrodes are removed. 0.1-1% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, intravitreous laser radiation is carried out in parallel light beam of wavelength equal to 661-666 nm is applied at a dose of 30-120 J/cm2.The transformed retina and tumor destruction products are intravitreally removed. Boundary-making endolasercoagulation of retinotomy area is carried out after having smoothed and compressed retina with perfluororganic compound. The operation is finished with placing sutures on sclerotomy and conjunctiva. Platinum, iridium or rhodium are used as the platinum group metals. Another embodiment of the invention involves adjusting position and size of the intraocular neoplasm in trans-scleral diaphanoscopic way. Rectangular scleral pocket is built above the intraocular neoplasm to 2/3 of sclera thickness with its base turned away from limb. Several electrodes are introduced into intraocular neoplasm structure via the built bed. The electrodes are manufactured from platinum group metal. Electrochemical destruction is carried out with the same current intensity in changing electrodes polarity and their position in the intraocular neoplasm space, and the electrodes are removed. Superficial scleral flat is returned to its place and fixed with interrupted sutures. 0.1-1% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg after having carried out vitrectomy and retinotomy. Visual control of intraocular neoplasm cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, intravitreous laser radiation is carried out in parallel light beam of wavelength equal to 661-666 nm is applied at a dose of 30-120 J/cm2. The transformed retina and tumor destruction products are intravitreally removed using vitreotome. Boundary-making endolasercoagulation of retinotomy area is carried out after having smoothed and compressed retina with perfluororganic compound. The operation is finished with placing sutures on sclerotomy and conjunctiva. Platinum, iridium or rhodium are used as the platinum group metals. The number of electrodes is equal to 4-8.

EFFECT: reduced risk of metastasizing.

4 cl, 13 dwg

FIELD: medicine.

SUBSTANCE: method involves building tunnel to posterior eyeball pole in inferoexterior and superexterior quadrants. The tunnel is used for implanting flexible polymer magnetolaser implant to the place, the subretinal neovascular membrane is localized. The implant has a permanent magnet shaped as a cut ring and is provided with drug delivery system and a short focus scattering lens of laser radiator connected to light guide. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 5-7 mTesla units intensity. It is arranged with its north pole turned towards sclera at the place of the subretinal neovascular membrane projection with extrascleral arrangement of laser radiator lens membrane being provided in the subretinal neovascular membrane projection area. The other implant end is sutured to sclera 5-6 mm far from the limb via holes made in advance. The implant is covered with conjunctiva and retention sutures are placed thereon. Light guide and drug supply system lead is attached to temple with any known method applied. Drugs are supplied via the implant drug supply system in retrobulbary way in any order. Triombrast is given in the amount of 0,4-0,6 ml and dexamethasone or dexone in the amount of 0,4-0,6 ml during 3-4 days every 12 h. 0.1-1% aqueous solution of khlorin is intravenously introduced at the third-fourth day after setting the implant as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, at a bolus dose of 0.8-1.1 mg/kg. Visual control of subretinal neovascular membrane cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the subretinal neovascular membrane with the photosensitizer to maximum saturation level, intravitreous, transretinal laser radiation of 661-666 nm large wavelength is applied at general dose of 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the subretinal neovascular membrane via laser light guide and implant lens, repeated laser irradiation of the subretinal neovascular membrane is carried out with radiation dose of 30-60 J/cm2.

EFFECT: accelerated subretinal edema and hemorrhages resorption; regression and obliteration of the subretinal neovascular membrane; prolonged vision function stabilization.

6 cl

FIELD: medicine.

SUBSTANCE: method involves filling vitreous cavity with perfluororganic compound. Two electrodes manufactured from platinum group metal are intravitreally, transretinally introduced into intraocular neoplasm. Electrochemical destruction is carried out with current intensity of 10-100 mA during 1-10 min in changing electrodes polarity and their position in the intraocular neoplasm space, and the electrodes are removed. 0.1-1% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, intravitreous, transretinal laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2 in perfluororganic compound medium. The transformed retina and tumor destruction products are intravitreally removed with perfluororganic compound volume being compensated with its additional introduction. Boundary-making endolasercoagulation of retinotomy area is carried out. The perfluororganic compound is substituted with silicon oil. The operation is ended in placing sutures over sclerotmy areas and over conjunctiva. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity. Platinum, iridium or rhodium are used as the platinum group metals.

EFFECT: complete destruction of neoplasm; reduced dissemination risk.

6 cl, 12 dwg

FIELD: medicine, applicable for stopping of pains of various nature.

SUBSTANCE: the device has a quantum-mechanical oscillator located in a casing, magnet, vessel for medicinal agent and a hollow cylinder. The magnet is installed between the oscillator and the vessel. Positioned in the vessel is a hollow cylinder having through holes on its surface.

EFFECT: quick and absolute anestesia.

2 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: method involves administering laser radiation therapy once a day using low intensity pulsating radiation of wavelength equal to 890nmand power density of 0.03 mW/cm2. Injured organ projection to frontal abdominal wall is exposed to radiation at the first laser therapy stage in two fields acting upon each field for 2 min with radiation pulse succession frequency equal to 80 Hz in applying stable contact-type method. Total treatment dose on two fields is equal to 0.008 J/cm2. The second laser therapy stage begins immediately after having finished the first one in applying radiation along the large intestine path using labile contact-type method in a way that radiation pulse succession frequency equal to 80 Hz is applied first during 1 min and then frequencies of 600, 150 and 300 Hz are applied also during 1 min, respectively. Total treatment dose is equal to 0.032 J/cm2 at the second stage. Total treatment dose is equal to 0.04 J/cm2 at both stages.

EFFECT: enhanced effectiveness in inhibiting dysbacteriosis; reduced frequency of postoperative complications.

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