A method of treating acute restricted pleural empyema with bronchopleural hiss

 

(57) Abstract:

The invention relates to medicine, namely to thoracic surgery. Sanitize the cavity empyema antiseptic solution. After the disappearance of purulent exudate in the pleural cavity is injected powdered placenta tissue. 4 - 6 days after the start of the gradual destruction of the contents of empyema cavity within 6 to 10 days. The method allows to increase the effectiveness of treatment and reduce mortality and complication rate.

The invention relates to medicine, specifically to surgery, and relates to methods of treatment of acute restricted pleural empyema with bronchopleural hiss and methods preparation of tissue of the human placenta.

There is a method of treatment of acute restricted pleural empyema with bronchopleural hiss through rehabilitation empyema cavity with antiseptic solutions.

However, this method is not effective enough due to the lack of effects on bronchial fistula. Recovery is achieved only 20 - 25% of patients [1].

There is a method of treatment of acute restricted pleural empyema with bronchopleural hiss by temporary occlusion widenesses bronchus.

However, this method Lecho. [2] This method because of its traumatic contraindicated for holding the patients with severe comorbidity. It has a low efficiency, recovery is achieved in 50% of cases, with mortality of 3.7%. Due to the progression of the destruction of the lung after obturation of the bronchus in 64% of patients there is a need to re-occlusion [3].

Known methods of treatment of acute restricted pleural empyema with bronchopleural hiss involving surgery. These include: thoracoplasty, thoracomyoplastic, decortication and pleurectomy.

However, these treatments have significant limitations due to the high morbidity. They cannot be used in patients with severe comorbidity. Postoperative complications thoracoplasties operations occur in 14%, and mortality in the 13 - 18% of cases. When performing decortication and pleurectomy complications occur in 5%, and mortality in 8% of patients. These operations are only possible in compensated patients and therefore are of limited use [4].

There is a method of treatment of acute restricted ambiem with bronchopleural hiss by tamponade empyema cavity by A. C. is 10%. The treatment of tamponade empyema cavity being characterized by a duration of 3 months or more [5].

The closest the mechanism of action of a prototype of the proposed method is a method of treating acute restricted pleural empyema with bronchopleural hiss through rehabilitation empyema cavity preparation with cauterizing and antiseptic - 30-50% solution of silver nitrate. Contact silver solution with the wall of the empyema cavity and bronchial hiss causes the development of aseptic inflammation and the growth of granulation tissue due to irritation.

However, this method has low efficiency. Recovery is achieved in 30% of patients in the presence of the fistula is not more than 3 mm in diameter. This method requires multiple repetitions and carries the risk of complications due to chemical aggressiveness of the solution [6].

Known methods of preparation of placental tissue for local use, which include money laundering, sterilization, canning and grinding placental tissue [8, 9]. Preparation of tissue these methods involves only the external effects on the placenta.

However, these methods preparation of placental t the e side effects.

The closest prototype to the proposed method is a method for preparing tissue human placenta by external laundering, handling with antiseptics and grinding placental tissue fragments from 0.5 to 1.5 cm [7].

However, this method of tissue preparation human placenta does not launder the bloodstream of the placenta from the contained blood, which can cause side effects. The size of the fragments of placental tissue obtained in this way, it is not possible to use them for insertion into the pleural cavity through the drainage tube or trocar.

The problem solved by this invention is to increase the effectiveness of treatment, reducing mortality and complication rates.

The problem is solved by laundering the bloodstream of the placenta from the blood, pounding her until a homogeneous mass with the subsequent introduction of a sanitized cavity empyema and removal of placenta tissue using pleural punctures in 4 - 6 days after introduction to the complete elimination of empyema cavity.

In the analyzed literature not found this combination of distinctive features and it is not obvious to a person skilled level of matelski level". These methods have undergone clinical trials in the Department of thoracic surgery of the Regional clinical hospital of the city of Tomsk, thus, they meet the criteria of the invention "Industrial applicability".

The method of preparing the placenta is as follows.

The placenta under aseptic conditions take in the room, not later than 4 hours after birth, in healthy women. In sterile containers delivered to the operating room.

The placenta is placed in a sterile tray. Outside washed from blood clots physiological solution of sodium chloride. After processing of the umbilical cord on Grossao - Piloncillo last cut at a distance of 5 cm from the place of attachment to the placenta. Allocate the vessels of the umbilical cord. In them are entered PVC catheters, which are fixed with interrupted sutures. The bloodstream placental tissue were washed off the blood of warm physiological solution of sodium chloride (36oC). Solution in 1 liter is pumped into the arteries of the umbilical cord using a roller pump of the NPM-1 with a speed of 25 revolutions per minute. Wash liquid flows through the umbilical vein. Then cut the umbilical cord at the base, with fruit remove surface water shell. The maternal surface of the placentae is solicitee tissue RT-1. The container is placed 100 g of placental tissue. Grinding is performed in the mode 4000 rpm for 30 seconds After grinding the tissue of the placenta takes the form of a homogeneous mass, the size of the fragments is from 2 to 5 mm.

A method of treating acute restricted pleural empyema with bronchopleural hiss.

A patient with acute limited empyema conducts the removal of purulent content by active aspiration drainage or by puncture of the pleural cavity. Reorganization carried out with an antiseptic solution for 5 to 10 days before the disappearance of purulent exudate. In the absence of positive dynamics in the two weeks after rehabilitation cavity empyema patient injected into the cavity empyema shredded tissue of the placenta.

Introduction minced placental tissue in the pleural cavity are carried out through the trocar or the drainage tube of Janet's syringe or other means available. With the introduction of minced placental tissue through the drainage tube last removed.

The number of input minced placental tissue depends on the size of the empyema cavity, which is determined by the three-position pleurogramma. The amount of injected tissue placently empyema by puncture of the pleural cavity. First performed on 4 - 6 days since the introduction of the placental tissue. Next puncture perform daily, removing air, fluid and placenta tissue to gradually reduce the size of the empyema cavity. The volume of removed tissue of the placenta from the cavity for single puncture should not exceed a quarter of the original volume injection. Puncture performed to remove placental tissue and exudate from the empyema cavity within 6 to 10 days.

Clinical examples.

Patient Glacier S. C., 19 years old, medical History, N 182, enrolled in the division of thoracic surgery Bureau, Tomsk 1.07.96 year. When entering a state of extreme severity, expressed phenomena of intoxication. On radiographs of the chest picture right total hydropneumothorax. Performed drainage of pleural cavity is evacuated to about 1 liter of pus, when the suction negative pressure in the pleural cavity was not created. Conducted antibacterial and detoxification therapy, rehabilitation empyema cavity dioksidin, boric acid, sodium hypochlorite. After normalization of the total state 1.08.97 year made a temporary occlusion of the proximal bronchus of the right lung. When ANVISA and in the upper part. The obturator is removed. Pleurogramma from 16.08.96 year residual cavity 14 x 12 x 4 see 16.08.96 year in the cavity empyema introduced 500 ml of crushed placental tissue. The drainage tube is removed.

21.08.96 year on the fifth day after the introduction of placental tissue puncture performed empyema cavity. Removed 100 ml content pleural exudate and shredded tissue of the placenta. When removing the air negative pressure in the pleural cavity was not created, however, the rate of admission of air when the suction has decreased. In the next three days consisted of puncture empyema cavity to remove the content in a volume of 100 ml per puncture. 25.08.96 year at the puncture cavity received only 50 ml content - placental tissue and exudate. Pleurogramma from 26.08.96 year residual cavity 2 x 2 x 3 see 28.08.96, puncture of pleural cavity content is not received. The x-ray light straightened, empyema cavity is not defined. The patient was discharged with recovery.

The effects of placental tissue in the cavity of acute empyema with bronchopleural hiss and advantages of the proposed method of preparation of placental tissue.

The mechanism of action of placental tissue in the course of renewal the od N. L. Kapelushnik, 1954, P. M. Buiko, 1948, V. P. Filatov, 1933, M. Pittoni, 1951, C. Sneyd, 1951, and others). The placental tissue was used as a graft in the surgical treatment of hernias, in dentistry, to strengthen communications with resection of the stomach and intestines, fistulography in the treatment of urinary and intestinal-vaginal fistula.

The fabric of the human placenta is rich in various bioactive substances and hormones that promotes vigorous growth of granulation tissue and nutrient stimulation of the body, local softening of scar tissue and improve elasticity [7, 10, 11].

It is known that on the fourth day after the transplantation of placental tissue is strong growth of granulation tissue, and by the end of the second week of the formed fibrous tissue that completely covers any defects [10].

The introduction of the crushed mass of the placenta into the cavity empyema on the proposed method provides a modified contact inflammation of the pleura and the mouth of a bronchial fistula with placental tissue. The stimulation of regeneration processes, enhancing growth of granulation tissue, the formation of connective tissue and ultimately closing bronchiolitis manual retrograde obturation widenesses bronchus, which prevents the development of re-infection and flotation visceral piece of pleura during respiration thereby creating favorable conditions for healing of bronchial fistula.

Thus, the introduction of minced placental tissue into the cavity empyema patients with acute limited empyema with bronchopleural hiss provides a significant strengthening of processes of regeneration and creates favorable conditions for the closure of bronchial fistula. The ability of placental tissue to soften scar tissue and improve the elasticity of the latter contributes to the smoothing of the lung in the presence of thickened visceral pleura and pleural growths.

Using this method allows you to achieve recovery in 64% of patients with acute limited empyema with bronchopleural hiss, in the absence of complications. Contra-indications for its use have not been identified.

Preparation of placental tissue under the proposed method removes blood from the body as a result of laundering the bloodstream. Due to this, removed the negative effects that result from lysis of blood. Lisarow the th to activate microorganisms.

Chopping placental tissue until a homogeneous mass considerably facilitates its introduction into the pleural cavity through a small hole in the chest.

Literature

1. Surgery of the lung and pleura. Edited by academician of the Academy of medical Sciences of the USSR I. S. Kolesnikov and Professor M. I. Lytkina. 1988. Leningrad. p. 205.

2. Therapeutic tactics in varying degrees leaks damaged lung. The Hydrographic System Of Cacheral, S. A. Shalaev, B. M. Kucher, V. I. Popov, V. C. Lishenko, M. I. Zamyatin, C. I., Vasileska, C. A. Abakumov. Military Medical Academy, Saint-Petersburg. Bulletin of the surgery. I. I. Grekova, volume 15 No. 1, 1995, page 47.

3. Pyopneumothorax. N. In.C.R., Y. N. Levashev, Centuries Kokhanenko. 1988. Chisinau. pages 178-179.

4. The treatment of pleural empyema. C. I. Maslov. 1976. Leningrad. pages 136-137.

5. Treatment of the pleura. C. I. Maslov. 1976. Leningrad. pages 63-64.

6. Surgery of the lung and pleura. Edited by academician of the Academy of medical Sciences of the USSR I. S. Kolesnikov and Professor M. I. Lytkina. 1988. Leningrad. page 223, 225.

7. Materials on transplantation of placental tissues. C. M. Macroses. Collection of scientific papers. Bashkir medical Institute. Volume 17, 1968. p. 259.

8. The use of placental graft at operationsresearch. 1962. pages 8-9.

9. Use canned placental tissue at the surgical clinic. M. H. Jahangirov. Proceedings of the Andijan Institute of medicine. 1971.

10. The use of placental tissue graft in surgical treatment of urogenital and intestinal-vaginal fistula. Tomsk medical Institute. Abstract K. I., Palaiko. Krasnoyarsk. 1962. page 4-6.

11. Biologically active substances associated with the placenta. M. S. Lomakin, N. G. The Artsimovich. Obstetrics and gynecology N 9. 1991.

A method of treating acute restricted pleural empyema with bronchopleural hiss, consisting in rehabilitation cavity empyema antiseptic solution, characterized in that after the disappearance of purulent exudate in the pleural cavity is injected washed from the vascular bed and crushed before the formation of a homogeneous mass with the size of the fragments of 2.0 - 5.0 mm placenta tissue and for 4 - 6 days after the start of the gradual destruction of the contents of empyema cavity within 6 to 10 days.

 

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FIELD: medicine, veterinary science, cosmetics.

SUBSTANCE: bioconcentrate is prepared from placenta by treatment of intact placenta of native structure with hydrophilic organic solvent at temperature 0-25oC for 3-8 h at M = 5-30. Bioconcentrate represents extract containing lipoprotein complex enriched with water-soluble and lipid-soluble vitamins and a solid residue containing glycolipoprotein including protein, polysaccharide, nucleoprotein and lipid components. Invention provides the development of the wasteless manufacturing bioconcentrate eliciting high stability at storage and high biological activity that allow expanding region in applying bioconcentrate and to develop the broad spectrum of medicinal and cosmetic formulations used in medicine, veterinary science and cosmetics. Invention can be used as an agent normalizing the metabolism in different organs and tissues and eliciting the reparative and anti-inflammatory effect.

EFFECT: improved preparing method, valuable medicinal properties of bioconcentrate.

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