The method of treatment of ischemic heart disease

 

(57) Abstract:

The invention relates to medicine, in particular to the treatment of ischemic heart disease. On the background of a General therapeutic measures, conservative medical treatment laser irradiation on cutaneous region of the heart with 1-2 fields in pulsed mode from a distance source - skin 6-10 cm, wavelength 575-630 nm, a pulse repetition frequency of 1-3 Hz and pulse energy of 0.25-0.5 MJ at 120-140 pulses per session. Irradiation is carried out 5 times per week, 5-10 sessions per course of treatment with repeat courses in 0.5-2 months before full recovery. As a result of such non-invasive effects no danger of mechanical damage, infectious and thromboembolic complications with maintaining a high therapeutic efficacy. table 1.

The present invention relates to medicine, in particular to the treatment of internal diseases.

There are different ways of treatment of ischemic heart disease, including health-building activities, conservative medical therapy, endovascular methods (intracoronary thrombolysis, balloon dilatation of the coronary arteries), interkorean thrombendarterectomy, lipoproteins - hemosorption, plasmapheresis, immunities, elektrosrbija [1 - 3].

According to the authors stabilization process occurs in 50 to 80% of cases, myocardial infarction in 10 - 24% of cases, letalnosti reaches 3,4 - 7%. In addition, in most cases there is intolerance medications or reducing their effectiveness with prolonged use.

The closest is intravenous blood irradiation helium-neon laser 10 minutes each day, wavelength 630 nm, average power of 2.5 - 3 MW. A total of 20 sessions [4].

However, this method requires the introduction into the bloodstream of fibers, complicated measures sterilization, paired because of the invasiveness with the possibility of bacterial or viral infection of patients, thrombosis of the vascular bed, and does not allow long-term use and frequent repetition of courses of therapy.

However, the use of transcutaneous laser therapy using a helium-neon laser was ineffective [5].

The technical essence of the invention is to eliminate possible mechanical damage, infection and tromboamboliceski complications during the LAZ the treatment of ischemic heart disease, includes General activities, conservative medical therapy and laser therapy, according to the invention of the laser irradiation performed percutaneously in the region of the heart with 1 - 2 fields in pulsed mode from a distance source - skin 6 - 10 cm wavelength 575-630 nm, repetition rate 1 Hz to 3 Hz and pulse energy of 0.25 - 0.5 MJ 120 - 140 pulses per session, 5 times a week, 5 to 10 sessions per course of irradiation, with repetition through 0.5 - 2 months before full recovery.

The method is as follows. After a comprehensive evaluation, establishing indications for conservative treatment and assignment of appropriate therapy defines the fields for exposure to laser radiation.

The center of the field is determined by the fifth Mirabello on the left mid-clavicle line and the fourth Mirabello on parenteralnoe line on the left. The distance between the end face of the fiber and skin set within 6 - 10 see Then irradiated in the fields of laser beam in a pulsed mode with a pulse repetition frequency 1 Hz to 3 Hz, the wavelength 575 - 630 nm, pulse energy of 0.25 - 0.5 MJ 120 140 total pulses on both fields for the session. Irradiation is carried out 5 times per week 5 - 10 sessions per course is th way studied 112 patients with coronary heart disease aged 42 to 73 years (mean age of 61.5 years). All patients were male.

Patients with angina pectoris I functional class (FC) was 31 (laser therapy was performed in 14), HK - 33 (laser therapy 20), FC - 34 (laser therapy - 19), IV - 16 (laser therapy - 9). All patients received antianginal therapy, intensity is identical in the control and experimental groups in each functional class. When evaluating the results of treatment used the following criteria: well-being of patients, the results of Bicycle ergometry - (VEM), the trade-mil-test (TT), the volume of antianginal therapy, and laboratory indicators. The following results are obtained (see table).

Thus, in the group of patients receiving conservative treatment, improvement occurred in 25 (48%) patients, the condition has not changed in 25 (48%) patients, and worsening occurred in 2 (4%) patients. In the group of patients who received additional laser therapy, the figures were different: respectively 45 (72%), 14 (23%) and 3 (5%). In addition, in an experimental batch was higher than the frequency of complete disappearance of angina attacks, significantly higher was the frequency of reducing the amount of strokes on the background of decreasing doses of antianginal drugs. During the test VEM and TT at the end of the course l is the group of patients receiving laserotherapy (62), FC is changed downward in 9 (14,5%) patients (p < 0,05).

Thus, supplementation in the treatment of patients with IVS cutaneous laser therapy on the proposed method is characterized by the absence of danger of mechanical damage, infection and tromboamboliceski complications due to the impact of non-invasive maintain a high therapeutic efficacy.

Example 1. Patient W. , 56 years, with coronary artery disease typical symptoms of angina for over 10 years, constantly taking different combinations of antianginal drugs. Angina occurred more frequently when the loads are emotional. Hospitalized due to worsening ECG. In part on the ECG have been significant changes in the myocardium, lack of blood supply to the myocardium in the anterior-septal area and the side wall (decrease T to 1.5 - 2 mm from the contour). When VEM sample thorn was 75 watts at Echo KG-FI - 42,3%, spotkanie LCA and PKA, reduced contractility. After a course of laser therapy (the distance between the radiation source and the skin of the patient 5 cm, number of sessions -10, the parameters of laser radiation 575 nm, pulse energy of 0.25 MJ, frequency postingannya funds (nitroglycerin, sustak-Forte, Kordofan) angina passed at all. Thorne increased to 100 watts. After 6 months the patient was able to reduce the dose sustak-Forte from 4 to 2 tablets, to exclude the admission of Kordofan and nitroglycerin. Angina was not renewed. Load limits.

Example 2. Patient G. , 73 years old, retired, suffered from coronary heart disease in the form of typical anginal attacks and cardiac arrhythmia type permanent atrial fibrillation and ventricular ekstrasistolii for 25 years, exercise tolerance corresponded III functional class, constantly taking adequate doses of proangiogenic antianginal and antiarrhythmic drugs. In the hospital he was sent in connection with the frequent attacks of angina. Voltage, accompanied by deterioration of blood supply to the myocardium in subendocardial layer of the left ventricle, frequent ventricular extrasystoles. In addition, the patient had severe pain in the shoulder joints and spine, which was interpreted as stenokardicheskie equivalents. After 5 sessions of laser therapy, which was held at the intersection of 5 ribs and left parenteralnoe line field radiation with a diameter of 6 cm under the conditions: the distance the teachings 3 Hz, the pulse energy of 0.5 MJ, the number of pulses of radiation 140. The treatment was performed in patients receiving conventional doses of nitrosospira and corinfar (80 and 40 mg per day). Indicated the disappearance of strokes in the same amount of motor activity, disappeared ventricular extrasystoles, cardiac rhythm became closer to nanosustain without assigning glycosites and drugs that would affect atrioventricular conductivity, and additional laser influence on painful points along the spine and shoulder joints allowed after the 3rd session to relieve the patient from the pain. Treatment soputstvovala joint disease was more successful, because the presence is often recurrent ulcers of the stomach and proctosigmoiditis receiving nonspecific drugs in the form of tablets and candles was not possible.

Sources of information

1. Konyaev B. C. Ischemic heart disease, angina. The management, diagnosis and treatment of internal diseases, edited by F. Komarov I. Medicine. 1991, T. 1, main 3, S. 110-112.

2. Gotman L. N. Endovascular surgery, M.: Medicine, 1987

3. Sacaba I. K. Coronary heart disease. Manual of cardiology under the editor is inongo effect of helium-neon irradiation of blood. Laser and medicine. Tashkent, 1989, H. 1, S. 89-90. Prototype

5. Korochkin, etc. the Effectiveness of helium-neon irradiation in unstable angina. Lasers and medicine. Tashkent, 1989, H. 3, S. 135.

A method of treating ischemic heart disease, including health-building activities, conservative medical therapy and laser therapy, characterized in that the irradiation is carried out by percutaneous laser in the region of the heart with 1 - 2 fields in pulsed mode from a distance source - skin 6 - 10 cm, a wavelength of 575 - 630 nm, a pulse repetition frequency 1 Hz to 3 Hz and pulse energy of 0.25 - 0.5 MJ 120 - 140 pulses per session, 5 times a week, 5 to 10 sessions per course of treatment with repeat courses in 0.5 - 2 months before full recovery.

 

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The invention relates to medical equipment

FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.

3 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule of 3-4 mm in size in choroid hemangioma projection to sclera 3-4 mm far from limb. Tunnel is built between sclera and Tenon's capsule to extrasclerally introduce flexible polymer magnetolaser implant through the tunnel to the place, the choroid hemangioma is localized, after performing transscleral diaphanoscopic adjustment of choroid hemangioma localization and size, under visual control using guidance beam. The implant has permanent ring-shaped magnet in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 2-3 mTesla units intensity. It is arranged with its north pole turned towards the choroid hemangioma so that extrascleral implant laser radiator disposition. The other end of the implant is sutured to sclera 5-6 mm far from the limb with two interrupted sutures through prefabricated openings. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. 0.1-1% khlorin solution is injected in intravenous bolus dose of 0.8-1.1 mg/kg as photosensitizer and visual control of choroid hemangioma cells fluorescence and fluorescent diagnosis methods are applied. After saturating choroid hemangioma with the photosensitizer to maximum level, transscleral choroid hemangioma laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm with total radiation dose being equal to 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 intraocular neoplasm, repeated laser irradiation of the choroid hemangioma is carried out with radiation dose of 30-60 J/cm2.

EFFECT: enhanced effectiveness of treatment.

4 cl

FIELD: medicine.

SUBSTANCE: method involves creating tunnel between sclera and Tenon's capsule in intraocular neoplasm projection. Intraocular neoplasm localization and size is adjusted by applying transscleral diaphanoscopic examination method. 0.1-0.3 ml of photosensitizing gel based on viscoelastic of hyaluronic acid, selected from group containing chealon, viscoate or hyatulon, is transsclerally introduced into intraocular neoplasm structure using special purpose needle in dosed manner. The photosensitizing gel contains khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-1% by mass. Flexible polymer magnetolaser implant is extrasclerally introduced into the built tunnel in intraocular neoplasm projection zone under visual control using guidance beam. The implant has permanent ring-shaped magnet axially magnetized and producing permanent magnetic field of 3-4 mTesla units intensity, in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The implant is arranged with its north pole turned towards the intraocular neoplasm so that implant laser radiator lens is extrasclerally arranged in intraocular neoplasm projection zone. The implant light guide is sutured to sclera 5-6 mm far from the limb with single interrupted suture. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transscleral intraocular neoplasm laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm. The treatment course being over, 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, neodymium-iron-boron or samarium-iron-nitrogen. 0.1-1% khlorin solution as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is additionally intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg and repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2 15-20 min later during 30-90 s.

EFFECT: complete destruction of neoplasm; excluded its further growth.

4 cl

FIELD: medicine.

SUBSTANCE: method involves applying transscleral diaphanoscopic examination method for adjusting intraocular neoplasm localization and size. Rectangular scleral pocket is built 2/3 times as large as sclera thickness which base is turned from the limb. Several electrodes manufactured from a metal of platinum group are introduced into intraocular neoplasm structure via the built scleral pocket. Next to it, intraocular neoplasm electrochemical destruction is carried out in changing electrodes polarity with current intensity of 100 mA during 1-10 min, and the electrodes are removed. Superficial scleral flap is returned to its place and fixed with interrupted sutures. 0.1-2% 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 is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transpupillary laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2. the operation is ended with placing sutures on conjunctiva. Platinum, iridium or rhodium are used as the metals of platinum group. The number of electrodes is equal to 4-8. 0.1-1% khlorin solution, selected from group containing photolon, radachlorine or photoditazine, is additionally repeatedly intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2.

EFFECT: complete destruction of neoplasm; excluded tumor recurrence; reduced risk of tumor cells dissemination.

3 cl, 3 dwg

FIELD: medicine.

SUBSTANCE: the present innovation deals with treating vascular cutaneous neoplasms, such as nevus flammeus and gemangiomas. Light-thermal impact at energy ranged 39-47 J/sq. cm should be performed in two stages, and between them, 2-3 wk after the onset of vascular resistance at the first stage one should perform beta-therapy daily for 2-3 d at single dosage being 20 g. Then, 3 wk later it is necessary to conduct the second stage of light-thermal impact by starting at energy value being 42 J/sq. cm, not less. The method enables to shorten therapy terms due to applying combined method to affect vascular cutaneous neoplasms.

EFFECT: higher therapeutic and cosmetic effect.

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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