The method of treatment of acute osteomyelitis

 

(57) Abstract:

The invention relates to medicine, namely to methods of treatment of acute osteomyelitis. For this patient since admission to the hospital along with the traditional comprehensive therapy impose additional neovir or cold intramuscularly through a 5-7 day course of injections 4-6 mg/kg total dose 500-1600 mg treatment under the control of the interferon status. The method allows to increase the effectiveness of treatment of acute osteomyelitis and contributes to disease by cutting option, accompanied by a decrease intoxication increased levels of total serum interferon and absence of bone-destructive changes within 2-3 months from the onset of the disease. table 1.

The invention relates to the field of medicine, and specifically to methods of immunotherapy of diseases associated with decrease in humoral and cellular resistance, in particular to methods of treatment of acute osteomyelitis.

Known methods of complex treatment of acute hematogenous osteomyelitis, including osteoarthriti, sanitation and drainage of purulent foci, antibacterial, detoxification, desensitized, IMM is., Akihito, N., Galeev, M. A., Takhautdinov C. G., Yudin, J. B. "Osteomyelitis", M. Medicine, 1986, S. 91 - 154. However, despite intensive adjuvant therapy, the transition from acute to chronic stage is 20 - 60%. If we add to this that most authors unreasonably consider objective criterion of chronic osteomyelitis obligatory presence of sequestrum and sequestrating box, as opposed to persistent changes in the bone tissue for 3 to 4 months from the onset of the disease, the data on the transition in the chronic stage will be even higher.

As acute osteomyelitis always runs in the background of altered immunity, an important component of treatment of such patients is the normalization of the natural defenses of the organism.

With this purpose, widely used leukocytic mass, hyperimmune serum, plasma, gamma-globulin, directed, generally, to staphylococcal and streptococcal infection.

The disadvantage of these treatments is the inappropriate use of these drugs for other microbial etiology of osteomyelitis, the possibility of allergic reactions, the risk of being infected with viral hepatitis, HIV infection.

Closest to the proposed agelou localized infection, described by Samigina S. A. et al. in the article "Purulent surgical infection in newborns and clinical and immunological effect of decaris". Surgery, 1986, 8, S. 21 - 26. This method includes the traditional therapy and the introduction of more on her background decaris.

However, the inclusion of decaris in the complex therapy of children with acute hematogenous osteomyelitis leads to normalization only phagocytic activity of neutrophils and monocytes, whereas the most significant in the stimulation of the immune system is the normalization of interferon status, cytological function, macrophage-macrocytic system, etc.

The objective of the invention is the improvement of efficiency of treatment of acute osteomyelitis and, accordingly, the reduction of treatment time and reducing the frequency of transition in the chronic stage.

This problem is solved due to the fact that on the background of the traditional complex therapy is conducted additionally stimulation of immunity by the introduction of inductors interferonogenesis class Neovir" in a dose of 500 - 1600 mg per treatment course under the control of the interferon status.

The method is as follows. In the complex of traditional therapeutic interventions, including rehabilitation of purulent PTS and antioxidant therapy is the stimulation of immunity by the introduction of inductors interferonogenesis type "Neovir", "Cold". Stimulants interferonbeta injected from receipt of the patient intramuscularly day course 5 - 7 injections at a dose of 4 - 6 mg/kg under the control of the interferon status. With a considerable reduction interferon status, manifested by insufficient production of endogenous interferon, a second course of treatment. Preparations of type "Neovir", "Cold" have the ability to induce in the body high titers of endogenous interferons, in particular interferon alpha, with detectable serum titers of interferon introduction 500 mg "Neovia" corresponds to the introduction of 6 - 9 million M. E. reaferona.

"Neovir" as a stimulator of interferonbeta used in treatment of 8 patients with acute hematogenous osteomyelitis. A comparative analysis conducted with 58 patients with acute hematogenous osteomyelitis in the complex treatment which was applied decaris or T-activin.

In the group of patients who were administered interferon inducers, there was a clear clinical improvement compared with the control group, which was expressed in a more rapid normalization of body temperature, reducing symptoms of intoxication, the improvement techiemoe improvement was confirmed by x-ray data, advantage allows to use RTM, imaging and laboratory studies (see the following table. )

The table shows that the use of stimulants interferonbeta in the complex treatment of acute hematogenous osteomyelitis leads to reduced leukocyte index of intoxication in experimental group patients 6.5 times. For the control group of patients who interferon inducers has not been applied, there was a decrease leukocyte index of intoxication 4.1 times. Found that the elevated levels of serum interferon, which is observed in acute inflammatory diseases and characterized by normal reactivity of the organism in patients with acute hematogenous osteomyelitis is not marked. It shows weak reactivity of the organism and determines the appropriateness of stimulants interferonbeta. After the course of medication - inducers interferonogenesis the content of total serum interferon - base indicator interferon status - increased 3.7 times. The control group of patients the elevated levels of serum interferon were not recorded.

In 30 out of 58 patients of the control group marked continue the education, acute hematogenous osteomyelitis proceeded by cutting option, and within 3 months he cured all the sick.

As an example, have the following clinical observations:

Patient S. , aged 6, history 11467, was admitted to the Department of purulent surgery Children's regional hospital in Nizhny Novgorod 23.11.96. for acute hematogenous osteomyelitis of the upper metaphysis of the left shoulder. Hospitalized for 3 days of onset. 20.11.96. pains in the left shoulder, body temperature rise up to 38oC. the State of admission heavy. Severe pallor of the skin and visible mucous membranes. The child is lethargic. The body temperature of 38.5oC, the left shoulder is given to the body. The movement in the shoulder joint are severely limited. Swelling of the upper third of the left shoulder, here a sharp pain on palpation and axial load. In the analysis of a blood: erythrocytes 3,3 1012/l, hemoglobin 90 g/l, leukocytes 14,0 109/l with a shift of leukocyte formula to the left, ESR 35 mm/h, LII on Calf-Caliph 2,35. The content of serum interferon 6 M that is, When measuring the temperature increase in the upper third of the shoulder compared to the symmetric area 1.5oC. When televisio C. Ultrasonography revealed no pathology.

In an emergency order processed: decompressive osteoperforative upper metaphysis of the left shoulder. Of perforations under pressure stood out pus, detachable taken for bacteriological, cytological study. Cytological study on the background of continuous fields of erythrocytes marked neutrophilic leukocytes, lymphocytes, macrophages, Polyplast, osteoclasts. Bacteriological examination of inoculated Staphylococcus aureus. Conducted antibacterial therapy:/venous introduction of ampioks, gentamicin, detoxification therapy intervene introduction physiologic saline, gemodeza, desensibiliziruyuschee therapy - diphenhydramine/muscle, Vitamin B1B6. A course of interferon inducer "Neovir" 125 mg/muscle a day, 5 injections. Heading dose of 625 mg On the second day after the introduction of the "Neovia" body temperature began to decrease and reached normal values for 4 days. Significantly decreased purulent discharge. The wound in the upper third of the shoulder was salpetersaure to 11 days after treatment. 14 days after admission to the hospital, the boy has become quite adoleta the same. Movement in the joints of the left upper limb in full, painless. When thermal study of a limited section of hyperthermia on the projection of the postoperative scar with a difference of temperature in the 1oC. ultrasound of the shoulder homogeneous structure. When advantage allows to use RTM in-depth study of the temperature of the upper third of the left shoulder thermoassimmetry not found. The control radiograph of the left shoulder in 2 projections shadow punch hole in the top metaphase shoulder. In the analysis of blood Leukocytes 4,4 109/l, erythrocyte sedimentation rate of 12 mm/h, LII 0,29. The content of serum interferon 16 M. E. underwent a second course of interferon inducer "Neovir" 5 injections of 125 mg/muscle through the day. The content of serum interferon 26 PM that is Discharged in a satisfactory condition 17.12.96.

The boy came for control tests 21.01.97. On the control radiographs destructive changes is not defined. Filling bone perforations in the upper third of the shoulder. When advantage allows to use RTM examination of the upper third of the shoulder thermoassimmetry is not defined. In the analysis of a blood: erythrocytes 3,6 1012/l, hemoglobin 120 g/l, leukocytes 6,6 109/l, the ptx2">

Thus, the use of stimulants interferonbeta in the complex treatment of acute hematogenous osteomyelitis contributes to the disease by cutting option, accompanied by reduced toxicity, increased levels of total serum interferon, lack of bone-destructive changes within 2 to 3 months from the onset of the disease.

The method of treatment of acute osteomyelitis by implementing traditional adjuvant therapy, including immune-boosting drugs, characterized in that the correct interferon status the introduction of interferon inductors class neovir, cycloferon in a dose of 500 - 1600 mg per treatment course.

 

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