A method for the treatment of lipoid necrobiosis

 

(57) Abstract:

The invention relates to medicine, namely to dermatology. Each session of laser therapy is carried out in two stages. The first of which produce percutaneous blood irradiation of laser light with a wavelength of 0,633 μm via a fibre-optic light guide, at the distal end of which is fixed reflector in contact with the skin surface in the area of projection of the cubital vein, when the power at the end of the light guide 20-25 mW and duration of exposure 20-25 minutes In the second stage, local radiation lesions of pulsed laser light with a wavelength of 0.89 micron contact method using radiant matrix consisting of 10 laser diodes when the power of each diode 6-8 W/pulse, pulse width 100 NS, the pulse frequency of 80 Hz or 150 Hz, exposure to field 1 or 2 min and the duration of exposure 8-12 minutes the pulse Frequency is changed every 3-4 sessions, sessions of laser therapy spend 5 days a week, at the rate of 10-12 sessions. The combined impact during each session allows you to increase the effectiveness of the treatment. 1 C.p. f-crystals.

The invention relates to medicine, and property named the I treatment of patients with lipid necrobiosis used a variety of methods. This glucose-lowering drugs, angioprotectors, antibiotics, corticosteroids, acetylsalicylic acid, cytotoxic agents, agents that improve the metabolic processes in the skin, antioxidants and lipotropic tools.

There is a method of treatment of lipoid necrobiosis skin helium-neon laser with a power flux-density of 0.25 - 5 mW/cm2with the exposure time of 3-10 minutes daily course 20-20 sessions (Korepanov C. I., Fedorov, S. M., Shulga Century A. "Application of low-intensity laser radiation in dermatology" (a practical guide), Moscow, 1996, page 27).

However, this treatment is not effective enough, as it involves external beam radiation lesions, which leads to insufficient penetration of laser radiation into the lower layers of the dermis and blood vessels of the skin. This method of treatment lipoid necrobiosis does not take into account the complex causal mechanisms of disease: changes in lipid peroxidation, terminal vascular disorders, changes in carbohydrate metabolism.

The invention is aimed at improving the treatment of lipoid necrobiosis by combining for each session percutaneous low-intensity irradiation of blood helium-neon laser and the locale is the fact that a method for treatment of lipoid necrobiosis each session of laser therapy is carried out in two stages, the first of which produce percutaneous blood irradiation of laser light with a wavelength of 0,633 μm via a fibre-optic light guide, at the distal end of which is fixed reflector in contact with the skin surface in the area of projection of the cubital vein, when the power at the end of the light guide 20-25 mW and duration of exposure 20-25 minutes, and at the second stage of the session of laser therapy, which is carried out immediately after the first, carry out local radiation lesions of pulsed laser light with a wavelength of 0.89 micron contact method using radiant matrix, consisting of 10 laser diodes when the power of each diode 6-8 W/pulse, pulse duration of 100 NS, the pulse repetition frequency of 80 Hz or 150 Hz, exposure to field 1 or 2 min and the duration of exposure 8-12 minutes, while the pulse frequency is changed every 3-4 sessions, sessions of laser therapy spend 5 days a week, at the rate of 10-12 sessions.

Optionally, spend 1 or 2 courses of therapy, similar to the first, with the interval between courses of 6-8 weeks.

Described the ing the blood, and the skin provides a broad range of therapeutic effects, thereby adjusting carbohydrate, lipid metabolism, indicators rheology and hemostasis of blood.

Percutaneous exposure to blood leads to a marked systemic action. Given the frequent combination lipoid necrobiosis with diabetes, this method has a high practical significance, because it allows one to correct metabolic disorders in these patients.

The infrared spectrum of the laser radiation has a greater penetrating power, high trapnest to vascular formations of the skin. Laser light infrared range has a positive effect on microcirculatory processes, which are the main pathogenetic factor leading to damage to the vascular wall and the appearance of skin manifestations.

The proposed method for the treatment of lipoid necrobiosis is as follows. For transcutaneous laser irradiation of helium-neon laser at the first stage of each session of laser therapy uses laser physiotherapy installation LFR installations-01 ("Anode", Russia) or other equipment with similar specifications, approved for use in medical practice. Radiation is applied to the skin with the help of filaments is plaster. Procedures are performed in the supine position, the effects of being the projection of the cubital vein at the contact stable technique in continuous mode, the radiation power at the end of the light guide 20-25 mW, duration of exposure 20-25 minutes

In the second stage of the session of laser therapy effects on areas affected by pulse laser radiation of the infrared range (wavelength of 0.89 μm). For these purposes applied laser therapeutic apparatus series "Mustang" (LLP firm "Technology", Russia) or other laser equipment with similar specifications, approved for use in medical practice. The irradiation is conducted by irradiating the matrix consisting of 10 laser diodes, stable contact method, when the pulse power of each diode 6-8 watts, frequency 80 Hz or 150 Hz, pulse width of 100 nm, exposure 1 min or 2 min, the duration of exposure 8-12 minutes the pulse Frequency is changed every 3-4 session. Sessions of laser therapy spend 5 days a week, around 10-12 sessions per course. Depending on the dynamics of the clinical picture it is recommended that repeat courses of therapy with an interval between courses of 6-8 weeks.

is 75% of patients, pronounced effect in 55% of patients.

One of the main pathogenetic mechanisms of development of lipoid necrobiosis is microcirculation disorder, diabetic angiopathy, hemorheological status and the hemostatic system. The proposed method of treatment improves the clinical symptoms, normalization of the status of geometrically in the skin.

Due to the high information content of the method of laser Doppler flowmetry to assess the condition of microcirculation in the skin of patients the lipoid necrobiosis. At study baseline perfusion of blood in the lesions on the analyzer capillary blood flow LACC-01 (SPE "Lazma", Russia) revealed increased levels of basal blood flow, on average, 49.1%, and the amplitude of vasumati - by 39.8% compared with apparently healthy skin. Average basal blood flow in the affected skin is 3,720,31 perfusion units in apparently healthy 2,250,2 perfusion units, the amplitude of vasumati - 1,80,22 and 1,10,34 respectively. In addition, in the area of the rash is logged reduction in microvascular reactivity: maximum postgemorragicheskih increase in thermoprobe is 40-80% from that in healthy skin.

After the wire is respectively) near the results in apparently healthy skin (2,250,2 and 1,10,34).

The following examples, based on the clinical material to illustrate the described method of treatment.

Example 1. The patient 59 years. Diagnosis: necrobiosis lipoidica, the classical form of the Urbach-Oppenheim. Ill for 2 years. Previously nothing was treated. Examination: on the front surfaces of both legs 2 hearth rounded represented spotty and patchy elements with a size of 2-3 cm and 5-6 cm in diameter with clear boundaries reddish-brown color with a yellowish tinge. In the lesions of multiple telangiectasias, slightly pronounced atrophy. The diagnosis was confirmed histologically: the epidermis is slightly thickened, hyperkeratosis. In the dermis marked extensive foci of necrosis of collagen fibers surrounded histiocytoma infiltrates with an admixture of lymphocytes and isolated giant cells. At colouring of Sudan III in the area of necrobiosis marked accumulation of fat in the form of small drops of rusty-brown color. Diabetes is not identified. Indicators glucose tolerance test in normal limits. Marked Hyper viscosity syndrome and hypercoagulation. Lipid metabolism is not altered. In the study of microcirculation in the lesions revealed a significant increase (4 times)new thermal test.

The patient underwent a course of laser therapy, which includes 12 sessions, held 5 times a week. In the first phase of the session was performed percutaneous exposure to blood helium-neon laser with power at the end of the light guide 25 mW, exposure duration 20 minutes Immediately after this in the second stage, each session was performed irradiation of lesions infrared laser light (wavelength of 0.89 μm) using a radiating matrix consisting of 10 laser diodes when the power of each diode 6 W/pulse, frequency 80 Hz and 150 Hz (changing the pulse frequency after every 3 sessions, starting with a frequency of 80 Hz), pulse width 100 NS exposure time 2 min on the field, 4 fields of radiation, 5 days a week, 12 sessions on the course. Upon completion of the course of laser therapy centers apostiles considerably pale. The new elements were noted. The basal level of blood flow and the amplitude of vasumati in the affected skin decreased 1.5 times; when thermoprobe occurrence postliberalism growth (170%) in response to standard normalized impact.

Example 2. Patient B., 60 years. Diagnosis: necrobiosis lipoidica, common form. Ill for 2 years. Previously used external hormonal PR is e lesions increased in size. On examination, the lesions were localized on the lateral surfaces of the thorax, anterior wall of the stomach, in the elbow joints on the front surfaces of the legs. The lesions presented spotted hselkovymi and patchy elements light pink color with clear boundaries in diameter from 2-3 mm to 3-4 cm Lesion on the lateral surface of the thorax on the left is accompanied by a marked infiltration. The lesions are localized on the shins and joints with telangiectasia, with marked atrophy.

Patient's diabetes is not known, but the level of glucose in the blood is above normal. Lipid metabolism (cholesterol, triglycerides, lipoproteins is increased. Marked Hyper viscosity syndrome and hypercoagulation plasma. In the study of microcirculation in the area of the lesions had elevated levels of basal blood flow in 3 times, the presence of high-amplitude vasumati, reducing postliberalism growth in response to the normalized thermal test at 70% compared with that in healthy skin.

The patient received 2 courses of therapy with an interval of 8 weeks. Each course consists of 12 sessions, held 5 times a week. During each session the patient was performed percutaneous l is ia 20 minutes Soon afterward, the lesions affected the radiating matrix laser light infrared range (wavelength of 0.89 μm). The matrix consisted of 10 laser diodes when the power of each diode 7 W/pulse, frequency 150 Hz - the first four sessions, 80 Hz - the following four sessions, 150 Hz - the last four sessions. The pulse duration 100 NS exposure time 1 min on the field, the total number of fields of action - 10. To reduce possible adaptation to the laser impacts must change the frequency characteristics of the impact and the intensity of the laser radiation.

After the 1st course of laser therapy new lesions appeared, a slight blanching lesions. After 8 weeks was held the 2nd course of laser therapy by the method described above. After a month of treatment there was a significant flattening of the infiltrative plaque elements, reducing the number of telangiectasia. The viscosity parameters were close to normal. The basal level of blood flow and the amplitude of vasumati lesions also were close to normal values. When conducting thermoprobe possibilitiesto growth in centers and apparently healthy skin was 220%.

Example 3. Patient N., 19. Diagnodent used heparin ointment jelly "Solcoseryl", "Actovegin, a hemostatic sponge. Without the expressed clinical effect. At survey: centers occupy the front surface of both legs with clear boundaries reddish-brown color with glitter. The Central area of foci presents marked atrophy with single telangiectasia. On the inner surface of both legs in ankle joints ulcer defects 1-2 cm in diameter with a slight discharge. The patient diabetes mellitus type 1, medium-gravity stage of subcompensation, diabetic nephropathy. In the analysis - enhancing lipid metabolism in 3 times, increased serum viscosity and plasma, increased clotting of plasma in 2-3 times.

In the study of microcirculation in the area of the lesions had elevated levels of basal blood flow to 2.5 times the amplitude of vasumati 2.2 times, no postliberalism growth in response to the normalized thermal test.

The patient was held on 3 courses of therapy with an interval of 6 weeks. Each course consisted of 10 sessions, held 5 times a week. Transcutaneous laser blood irradiation was carried out by helium-neon laser with power at the end of the light guide 25 mW, exposure duration 25 distorting ulcer defects. Exposure was carried out radiating matrix consisting of 10 laser diodes when the power of each diode 8 W/pulse, frequency 80 Hz and 150 Hz (changing the pulse frequency every 3 sessions, starting with a frequency of 80 Hz), pulse width 100 NS, exposure 2 min, 6 fields of influence. Duration 10 sessions.

Repeated courses of laser therapy was performed after 6 weeks (a total of 3 courses). On the background of the courses was observed scarring and permission ulcers, pre-existing for several years. The basal level of blood flow and the amplitude of vasumati in the field of lesions approached normal values. When conducting thermoprobe postgemorragicheskih increase was 160%. Normalized lipid metabolism, rheology and hemostasis of blood.

1. A method for the treatment of lipoid necrobiosis by laser, characterized in that each session of laser therapy is carried out in two stages, the first of which produce percutaneous blood irradiation of laser light with a wavelength of 0,633 μm via a fibre-optic light guide, at the distal end of which is fixed reflector in contact with the skin surface in the area of projection of the cubital vein, when mo is which is carried out immediately after the first, carry out local radiation lesions of pulsed laser light with a wavelength of 0.89 micron contact method using radiant matrix consisting of 10 laser diodes when the power of each diode 6-8 W/pulse, pulse duration of 100 NS, the pulse repetition frequency of 80 Hz or 150 Hz, exposure to field 1 or 2 min and the duration of exposure 8-12 minutes, while the pulse frequency is changed every 3-4 sessions, sessions of laser therapy spend 5 days a week, at the rate of 10-12 sessions.

2. The method according to p. 1, characterized in that it further spend 1 or 2 courses of therapy, similar to the first, with the interval between courses of 6-8 weeks.

 

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1 ex

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