Drug treatment for long-term healing of wounds and ulcers (options)

 

(57) Abstract:

The invention can be used to treat long-term healing wounds and trophic ulcers of different localization in the background of sensitization. To increase therapeutic efficacy, reduce side effects of medicines, broadening the spectrum of action on the wound or ulcer impose headbands with simeonedelinekermit aqueous solution in the following ratio, wt.%: ksimedon 0,8-1,4; hydrocortisone hemisuccinate 0,09-0,13; boric acid 1.5 to 2.5; distilled water - the rest, or ointment on lonlinessbelieve basis in the following ratio, wt.%: ksimedon 0,8-1,4; hydrocortisone hemisuccinate 0,09-0,13; boric acid 1.5 to 2.5; anhydrous lanolin 45,97-47,61, medical vaseline - rest, or powder on the powder in the following ratio, wt.%: ksimedon 0,8-1,4; hydrocortisone hemisuccinate 0,09-0,13; boric acid 1.5 to 2.5; talc medical - rest. Complications from the use of the drug is not marked. 3 c.p. f-crystals, 1 table.

The invention relates to medicine, in particular to surgery, and may find wide use in practice, treatment of long-term healing of wounds and ulcers braked sharply painful and are accompanied by itching, pain. We have repeatedly reported in the press (Izmailov, A. Autodermoplasty in clinical practice. - Kazan, 1980, which is confirmed by literature data (Sadykova Century, and other Vestn. hir. the 1982 - N 4. - S. 71 - 75).

The treatment of wounds and trophic ulcers is one of the most difficult problems of surgery. Countless variety of different mechanical and physical methods, surgical techniques and pharmacological agents testify about their inefficiency (Wounds and wound infection. Ed. by M. I. Kuzina, and C. M. Kostyuchenok. - M.: Medicine, 1981).

The use for these purposes hormonal preparations in the form of ointments (flutsinar and others), although it helps incase of dermatitis, but it is the oppression of the healing process, especially delayed the progress of epithelialization. In addition, granulation become loose, vulnerable and on uneven terrain. Such drugs do not possess antiseptic properties, and depression of local immunity contributes to the development and spread of infection (Pods Century. And. and other Guide purulent surgery. - M. : Medicine, 1984). Therefore, hormonal ointment is not recommended to apply at purulent wounds (Mashkovsky, M. D. Lenfestey apply ointment (sinalar-N, flutsinar) or creams that contain along with glucorticosteroids antibiotics (neomycin, gramicidin, and others). However, the inclusion of antibiotics increases the risk of developing dangerous complications and allergic reactions in the form of local and systemic manifestations.

Because of the wide variety of contraindications (heart disease, the presence of tumors and other) in this group of patients, it is impossible to use physiotherapy (ultrasound, UHF, ultraviolet irradiation, and others).

Long-term treatment, frequent finding in these patients lead to the accession of nosocomial multiresistant infections particularly difficult to treat - coli blue pus, which is found in 100% of cases. The wand helps to necrosis of tissues, prevents the formation of epithelium and granulation, and the engraftment of gerotranscendence.

The only available effective and cheap remedy against Pseudomonas aeruginosa is boric acid, which has strong antimicrobial activity. Boric acid inhibits the growth of Bacillus blue pus, contributes to the swelling of the cell colloids, transferring them from a semi-solid state into a liquid, accelerates the rejection of necrotic tissue, cleansing the wound surface (Ie clinical observations have shown, that in addition to positive bacteriostatic effect, the boric acid in known concentrations (2 to 5%) has side effects: severe local pain, bleeding tissue; delays the healing process, causing inhibition of Genesis epithelium, granulation tissue, and in some cases even the death of its surface layers.

Known drug - ksimedon [N-(B-oxyethyl)-4,6 - dimethylpyrimidin-2] - for the local treatment of long-term healing of wounds and ulcers (RF patent N 2063752, MPK, A 61 K 31/505, 1996), taken as a prototype.

The disadvantage of this drug is that its use does not disappear signs of eczematous dermatitis, which is a constant companion long-term healing of wounds and ulcers.

The aim of the invention is to increase therapeutic efficacy of treatment, reduce side effects of medicines, the extension of the spectrum.

This goal is achieved by the fact that a new drug with a higher therapeutic effect in the treatment of long-term healing of wounds and ulcers. The proposed drug has a polyvalent action napravlenii, antiallergic and antipruritic activity. In addition, the product provides a distinct growth stimulation of granulation and regional epithelialization, which reduces the time of treatment of wounds and ulcers.

The proposed drug product contains active substances and the drive. As the active components of the tool includes ksimedon - new pyrimidine derivative of the 3rd generation, hydrocortisone hemisuccinate and boric acid.

Ksimedon as a chemical compound known and described in the literature. This crystalline powder white to light pink color with so Kip. 137,5 - 139,5oC, soluble in water. Permitted by farmkomiteta USSR Ministry of health for use by adults as burns funds (ed. St N 1685454, class A 61 K 31/505, publ. 23.10.91 year), as well as for the local treatment of long-term healing of wounds and ulcers (U.S. Pat. RF N 2063752, MPK, A 61 K 31/505, 1996).

The product is offered in different dosage forms.

An aqueous solution ximeno-hydrocortisone-boric in the following ratio, wt.%:

Ksimedon - 0,8 - 1,4

Hydrocortisone hemisuccinate - 0,09 - 0,13

Boric acid and 1.5 - 2.5

Distilled water - the Rest is new, wt.%:

Ksimedon - 0,8 - 1,4

Hydrocortisone hemisuccinate - 0,09 - 0,13

Boric acid and 1.5 - 2.5

Anhydrous lanolin - 45,97 - 47,61

Vaseline medical - Rest

Climatologist.citation powder on the powder in the following ratio, wt.%:

Ksimedon - 0,8 - 1,4

Hydrocortisone hemisuccinate - 0,09 - 0,13

Boric acid and 1.5 - 2.5

Talc medical - the Rest is up to 100%

The drug is prepared as follows: mix the components in sequence: ksimedon, boric acid, water or anhydrous lanolin and vaseline medical or talc medical, last added hydrocortisone hemisuccinate, : i.e., solution, ointment, and powder (all proposed legform) is prepared according to generally accepted pharmacopoeial rules.

The proposed drug for its therapeutic effect on the body is not the sum of therapeutic action components, and represents a new drug with an unexpectedly higher therapeutic effect.

The drug is used as follows.

Appointed General nonspecific desensibiliziruyuschey therapy with the inclusion of antihistamines. The skin around wounds and ulcers carefully may circular gauze layer, which is placed a removable separate gauze napkins with the proposed drug. If you use the tool in the form of a solution, the wetting produce two times a day with intervals of 12 h with a change of the upper layers of bandages as they blot the wound contents. In the absence of spontaneous healing of wounds or sores produce kozhnoplasticescoy operation free graft with prior exposure of it to climatologist.citation solution 2 - 3 minutes of the last Application and apply the ointment to produce the graft and the surrounding skin and in the post-transplantation period until complete healing of the flap. Such a course of therapy, repeat in 3 to 4 months. once during the first year after the patient's discharge from hospital. Daily dressings produced within 10 - 12 days.

The treatment by the proposed method with the use of the drug (solution, ointment, powder) in the city of septic centre was carried out in 38 patients with long-term healing wounds and trophic ulcers of various origins. In 95% of patients had signs of General and local allergies. The ongoing autosinsurance contributed to the aggravation of trophic tissue changes. The Kai by desquamation of the epidermis. Nude epidermis was subjected to extraction in the center. Typically, the local stable dermatitis was observed on the background of allergic reactions.

Local manifestations in individuals with torpidly flowing wounds and ulcers were characterized by redness of the skin, atrophic granulations with purulent fibrinous coating, swelling, and often with no signs of epithelialization. Bacteriological study of wound exudate was found to increase microbial associations, most often took place staphylococci and Streptococcus and Proteus and sticks blue-green pus. Microbial factor exacerbated purulent-necrotic process. The control group was 26 similar patients treated in the traditional way with the use of boric acid and ximedona in the form of ointments and powder.

Clinical observation of patients treated with the proposed drug, showed a significant advantage of this drug over the traditional. Provide examples of effective clinical use of the drug for various values of the ingredients of the composition (wt.%).

Example 1. Patient S., aged 40, arrived 10.01.1988, with long-term healing wound back surface right on the camping unsuccessful autodermoplasty perforated skin flap. Wound h cm has a flat bottom with pale granulations. The application of a 10% aqueous solution of Ximena has led to some recovery of granulations, but a noticeable improvement in wound healing is not marked. Resorted to using climatologist.citation aqueous solution recipe, wt.%:

Ksimedon - 0,8

Hydrocortisone hemisuccinate - 0,09

Boric acid - 1,5

Distilled water - Rest

Already on day 3 positive dynamics. Signs of dermatitis gradually began to subside, granulation acquired by the end of the 2nd week. pink color appeared in regional and islet epithelialization. Made free autodermoplasty mesh flap. After discharge within 1 year was performed 10 - 12 day course of anti-relapse treatment by local applications of the proposed solution at intervals of 3 to 4 months. Permanent cure.

Example 2. Patient R. W., 62, entered July 11, 1994, with long-term healing of scar-trophic ulcers that occurred after a serious injury in 1993 was Twice made kozhnoplasticescoy operation, but the plague receival. This was preceded by pronounced persistent eczematous dermatitis. Objectively determined ulcer 7x7 cm at the bottom of tert is causa local use of the proposed climatologicalwarning ointment recipe, wt.%:

Ksimedon - 0,8

Hydrocortisone hemisuccinate - 0,09

Boric acid - 1,5

Anhydrous lanolin - 45,97

Vaseline - Rest

On the 24th day of the ulcer healed completely, formed a soft, painless scar. After discharge from the hospital twice conducted courses of anti-relapse therapy proposed by the tool. Came a permanent cure.

Example 3. Patient R., 59 years old, was admitted to the surgical clinic November 1, 1995, complaining of persistent debilitating pain in his left Shin. The patient feels that he is 2.5 years. Notes frequent allergic reactions not only medicines (antibiotics and other), and food (fish). More than 7 years, suffering from hypertension. Regular ulcer treatment with application of various ointments, including Simeonovo on lonlinessbelieve basis. Therapeutic effect is not observed. On the anterior surface of the tibia is determined ulcer 5x4 cm, with uneven edges, the bottom of which is covered with pathological granulations. The skin about ulcers inflamed, there are lots exfoliated epidermis. Assigned to combination therapy with inclusion climatologicalwarning powder in the following recipe, wt.%:

Ksimedon - 0,8 I z, 60 years, was admitted to the hospital on February 16, 1997, with a diagnosis of vasotropic ulcer of the left tibia. Duration of disease more than 20 years. Treated inpatient and outpatient. In 1992, transaction - saphenectomy left about varicose veins. The complex conservative therapy used simeonedelinekermit solution in the following ratio, wt.%:

Ksimedon - 1,4

Hydrocortisone hemisuccinate - 0,13

Boric acid - 2,5

Distilled water - Rest

March 3, 1997, the patient was discharged home with longer healed ulcer.

Example 5. Patient L., 44, was admitted to the Department of purulent-septic surgery September 1, 1998, with extensive long-term healing wound of the right shoulder with clear signs otolaryngolo dermatitis. First topically applied solution khidrapur, then ointment used in the following recipe, wt.%:

Ksimedon - 1,4

Hydrocortisone hemisuccinate - 0,13

Boric acid - 2,5

Anhydrous lanolin - 47,61

Vaseline medical - Rest

Came complete epithelialization of the wound. Recovery. Home issued September 24, 1998

Example 6. Patient F., 70 years old, was admitted with long-term healing wound right soupline in the hospital on the rear foot was determined by wound 6X10 cm with purulent necroticism bottom. Under General anesthesia performed mechanical necrectomy. Topically used powder "Khidrapur", wt.%:

Ksimedon - 1,4

Hydrocortisone hemisuccinate - 0,13

Boric acid - 2,5

Talc medical - Rest

Complete wound healing, discharged home on the 18th day after hospitalization.

Example 7. Patient F., 53, entered may 10, 1997, with long-term healing wound in the area of the sacrum. A year ago he received a serious trauma pelvic fractures. The bottom of the wound is covered with fibrin, granulation sluggish. Started combination therapy with the inclusion of local topical applications with Chidabaram" recipe, wt.%:

Ksimedon - 1,1

Hydrocortisone hemisuccinate - 0,11

Boric acid and 2.0

Anhydrous lanolin - 46,79

Vaseline medical - Rest

On the 12th day the wound was cleansed from the surgery fibrinous deposits and covered with bright granulations. Made successful autodermoplasty dermatomal flap. Home discharged June 8, 1997

Example 8. Patient I., aged 54. Was admitted to the hospital on February 25, 1996 with the disease Fournier. Happened exposure of the penis and scrotum. After how agressively to debride the scars were treated topically with a solution "Khidrapur" recipe, wt.%:

The wound surface was covered with bright, well krovosnabjaemah granulations. Made of composite plastic surgery of the skin. Discharged with full recovery.

Example 9. Patient C., 32 years old, was admitted to the Department of purulent-septic surgery on October 17, 1996, with an extensive wound in the front of the thigh and groin area. 3 months unsuccessfully treated in one of the city hospitals. Repeatedly made skin plastic surgery. Assigned to combination therapy. Topically applied first aqueous solution "Khidrapur", and then in the form of powder in the recipe, wt.%:

Ksimedon - 1,1

Hydrocortisone hemisuccinate - 0,11

Boric acid and 2.0

Talc medical - Rest

The wound is significantly decreased in size, covered with granulations. Autodermoplasty. Discharged with recovery

The antibacterial ability of the proposed drug solution and other preparative forms were significantly higher (5 times) known means in respect of staphylococcal and Escherichia coli.

In the clinical trials, all patients of the experimental group marked inhibition of growth of Escherichia coli, in which the control was not observed. The changing nature of the microflora CLASS="ptx2">

Comparative results of treatment effectiveness is known and suggested means the most expressive in terms of liquidation of eczematous dermatitis. Local positive effect in the experimental group was reflected in the rapid (2 to 3 days) relief of symptoms of eczema and dermatitis, decrease in swelling, the disappearance of redness, pain and maceration. Elimination of persistent painful eczematous dermatitis has led to a dramatic improvement of the mental status of the patient, normalization of sleep and appetite, increasing physical activity.

Earlier positive trend in the experience is manifested in the cleansing of the wound from the surgery fibrinous overlays, in the appearance of healthy granulation and epithelialization, high adhesive bandages. 9 patients healing was by epithelialization and formation of soft rolling scar. In the control marked spontaneous healing is only in 3 cases.

Successful skin-plastic surgery experience was carried out on 5 to 7 days earlier than in control, which significantly reduced the time of imposition of the patients in the hospital. Recurrence of ulcer occurred in 2 cases in the experimental group, the control - 6. It should be noted that the age of sableman the P CLASS="ptx2">

The drug was highly effective when values of the active ingredients listed in the table.

The drug concentrations less than the smaller number of active components is not very effective, and with concentrations of more large values of the active components is not appropriate.

Thus, the use of climatologicalwarning drug in treatment of patients with long-term healing wounds and trophic ulcers on the background of General and local allergies leads to rapid relief of symptoms of allergies, acceleration of epithelialization and formation of granulation. The proposed remedy helps to improve the results of skin plasticity, reduces the frequency of relapse.

therapeutic effect of the proposed drug was not obvious and is not, as shown in clinical trials, the sum of the effects of active components.

The proposed remedy can be recommended for wide application in surgery, traumatology, combustology.

1. Drug treatment for long-term healing of wounds and ulcers, containing the active principle and the underlying, characterized in that the active agent it contains N-(-xiaobaosg - anhydrous lanolin and petrolatum in a ratio of components, wt.%:

N-(-Oxyethyl)-4,6-dimethylpyrimidin-2(ksimedon) - 0,8 - 1,4

Hydrocortisone hemisuccinate - 0,09 - 0,13

Boric acid and 1.5 - 2.5

Anhydrous lanolin - 45,97 - 47,61

Vaseline - Rest

2. Drug treatment for long-term healing of wounds and ulcers, containing the active principle and the underlying, characterized in that the active agent it contains N-(-oxyethyl)-4,6-dimethyl-dihydropyrimidin-2(ksimedon), hydrocortisone hemisuccinate, boric acid, and as underlying - distilled water in a ratio of components, wt. %:

N-(-Oxyethyl)-4,6-dimethyl-dihydropyrimidin-2(ksimedon) - 0,8 - 1,4

Hydrocortisone hemisuccinate - 0,09 - 0,13

Boric acid and 1.5 - 2.5

Distilled water - the Rest

3. Drug treatment for long-term healing of wounds and ulcers, containing the active principle and the underlying, characterized in that the active agent contains from N-(-oxyethyl)-4,6-dimethyl-dihydropyrimidin-2(ksimedon), hydrocortisone hemisuccinate, boric acid, and as underlying - talc at a ratio of components, wt.%:

N-(-Oxyethyl)-4,5-dimethyl-digitope the Rest

 

Same patents:
The invention relates to medicine and can be used as an external remedy in the treatment of skin diseases
The invention relates to medicine, namely to methods for treating boils and carbuncles persons with symptoms of phlebitis venous face

The invention relates to medicine, can be used in the production of pharmaceuticals and for the creation of funds - ascorbylpalmitate emulsion for the treatment of dermatoses
The invention relates to medicines and can be used for the treatment of purulent wounds, phlegmon, bedsores and other pathologies caused by reproduction in wounds strains of microorganisms

The invention relates to pharmaceutical industry and relates to a pharmaceutical composition for use in powder inhalers

Solid dosage form // 2131244
The invention relates to medicine

The invention relates to medicine, in particular the production of therapeutic and prophylactic drug "Winius" from ambrosia with the addition of various components

The invention relates to pharmaceutical industry and relates to obtaining anestezirutmi-hemostatic drugs

The invention relates to medicine and veterinary medicine, namely to methods for enterosorbents
The invention relates to nanoparticles containing diagnostic or therapeutic agent, and to tyloxapol associated with such particles

The invention relates to the field of medicine and for the application of polymer alkylarylsulfonates for effective inhibition of oxidant in chemical or biological system, as well as medications, including those polymeric compounds
The invention relates to pharmaceutical industry and relates to injection or infusion solution of enrofloxacin
The invention relates to the field of medicine and for the treatment of diseases of musculoskeletal system: osteochondrosis, radiculitis, radiculoneuritis, arthritis, arthrosis

The invention relates to medicine, namely to surgery

The invention relates to a new injectable form of the therapeutic agent with antitumor and antileykemicheskoy activity

The invention relates to the field of medicine
Up!