The method of treatment and/or prevention of lesions of the soft tissues of the body

 

(57) Abstract:

The invention relates to medicine, and is intended for the treatment and/or prevention of lesions of the soft tissues of the body. For this purpose, diseased tissue or to tissue of the intended lesion affected by nitric oxide. The method allows to normalize microcirculation, improve tissue metabolism and accelerate regeneration. This improves the treatment and prevention of soft tissue lesions. 2 C. and 10 C.p. f-crystals.

The invention relates to the field of medicine, and more specifically relates to methods of treatment and prevention of various soft tissue lesions.

It can be successfully used in the treatment of wounds, burns, trophic skin ulcers and bedsores, ulcers of the stomach, as well as various other skin lesions, muscle, connective tissue, mucous, serous and synovial membranes, abdominal and pulmonary surgery and therapy, dentistry, urology, otolaryngology, dermatology, gynecology, rheumatology, Oncology and other areas of medicine.

In modern medicine currently the most widely used different ways of treatment of common, acute and slow-healing chronic wounds, burns, trophic I have Sistah membranes of the oral cavity, larynx, trachea and bronchi, urinary tract, serous membranes of the abdominal and pleural cavities, synovial membranes of joints, muscles and connective tissues.

Known, for example, a method of treatment of wound and inflammatory skin lesions, mucous membrane of the mouth area, stomach ulcers, and others (see, for example, Lasers in clinical medicine. Ed. by S. D. Pletnev. M.: Medicine, 1996 ), namely, that the affected surface is irradiated with low-intensity radiation of helium-neon or gallium arsenide infrared lasers in pulsed or continuous mode of generation to reduce inflammation and activation of reparative processes, for the prevention of sepsis and so on

Low-intensity laser radiation used in surgery, dentistry, dermatology, gastroenterology and other areas of medicine for the treatment and prevention of wound, destructive and inflammatory processes. The exposure time, number of sessions and the method of application (either directly or through a fiber optic cable and endoscopic devices) depends on the disease, the stage of the pathologic process, individual sensitivity of the patient to radiation and other factors.

However, viewplane long not healing wounds, venous ulcers and pressure sores, prevention of suppuration and other complications, effective treatment of chronic inflammatory process of the mucous membranes, internal organs, serous and synovial membranes, muscles, ulcerative lesions of the stomach and other

It is also known stimulating effect of drugs on the basis of collagen when applied topically to heal wounds, burns, trophic ulcers, damage to internal organs (liver, spleen), stomach ulcers, ulcerative stomatitis and gingivitis, and so on (see, for example, Schennikov I. A., Schechter, A. B. and other Collagenoplasty in medicine. M. : Medicine, 1978). Collagen preparations are used in the form of films, sponges, powders, gel and other forms. They consist of a number of medicinal substances, antiseptics, antibiotics, hemostatics, stimulants regeneration and other Drugs impose on the damaged surface directly or via an endoscope (gastric ulcer). The stimulating effect is based on the activation of macrophages, bacteriostatic antiseptic action and other medicinal substances contained in the products.

However, the use of collagen products limits the ability of immune reactions to the use of protein in the skin and mucous membranes.

Know of any other method of treatment of skin wounds and trophic ulcers (see, for example, Thick P. I., Postyshev C. K., Harutyunyan, B. N. Proteolytic enzymes immobilized on the fibrous materials in surgery, Yerevan, 1990), which consists in the fact that their close wound dressings with immobilized proteolytic enzymes - trypsin, collatina, lysozyme and other These enzymes facilitate the removal of necrotic debris.

However, quite a pronounced acceleration of the wound healing process in many patients, especially with chronic wounds, does not occur. Enzymes often inhibit wound healing by inhibiting the maturation of granulation tissue. In addition, the use of immobilized enzymes is limited to open wounds, they cannot be used for the treatment of lesions of the mucous membranes, internal organs and other soft tissues.

Also known is a method of treatment of various destructive and inflammatory lesions of the skin, muscles, connective tissue, mucous membranes and internal organs, serous and synovial membranes (see, for example, Mashkovsky M. D. Medicines. M.: Medicine, 1993) through the use of various drugs, in particular, the Budgeting and others), and taken inside.

However, the effectiveness of these drugs in chronic processes remains low, which makes us constantly to develop new methods of treatment.

Thus, none of the known methods of treatment of destructive and inflammatory skin lesions, mucous membranes, internal organs and serous membranes is not effective and does not solve the problem of treating diseases that cause these lesions.

There are also no effective methods of prevention of postoperative complications, including pus, dehiscence, fistula formation, and so on , as well as prevention of skin lesions, such as radiation dermatitis, radiation ulcers in radiation therapy of cancer patients.

The purpose of this invention is to provide such a method for the treatment and prevention of lesions of the soft tissues of the body, which would provide maximum normalization of impaired microcirculation, vascular and nervous trophism, stimulation of reparative processes in the affected tissue, as well as prevention of purulent and radiotherapy complications.

This task is solved in that a method of treatment of lesions of the soft tissues of the body of the bookmark is the inhibition of inflammatory processes and accelerate the process of regeneration, normalization of microcirculation disorders, improvement of tissue hemodynamics and tissue metabolism, nervous trophism, treatment and prevention of fibrotic processes, prevention of purulent, radiation and necrotic complications of pathological processes in soft tissues, and ultimately the most rapid and complete recovery of the patient, prevention of relapse.

On diseased tissue by nitric oxide, it is advisable to act immediately.

This makes it possible to more effectively influence the destructive treatment (wound), inflammatory and fibrotic lesions of the skin, muscles, connective tissue, joints, mucous membranes of the oral cavity, digestive, respiratory and urogenital tracts, the serous membranes of the abdominal and pleural cavities and internal organs.

On diseased tissue can be affected in a gas stream containing nitric oxide, obtained, for example, by passing air through an electric discharge or obtained by chemical reactions.

On diseased tissue act azotosodyerzhascimi drugs, generating nitric oxide in the affected tissue.

Nitric oxide Teleshova vessel, that the blood supply to the affected tissue. This allows us to improve hemodynamics and nervous trophism as the affected and surrounding tissue that strengthens the processes of regeneration and accelerates the healing of wound and trophic lesions.

When transplanting a graft of tissue by nitric oxide can be affected beforehand on the donor site and the area of future transplantation, and then transplanted flap.

It stimulates the microcirculation and metabolism in the donor area of skin or skin-muscle flap, accelerate the development of granulations on the site of the lesion, as well as the acceleration of engraftment of the graft and to prevent exclusion.

On diseased tissue of the mucous membrane of the internal organs, serous and synovial membranes, it is advisable to influence the nitric oxide through endoscopic devices.

This makes possible the effects of nitric oxide directly on various inflammatory, ulcerative or erosive lesions of the mucous membrane of the digestive tract such as the esophagus, stomach, intestine, respiratory tract, such as the larynx, trachea, bronchi; urinary tract such as the bladder and so on; and that is opractice lesions in soft tissue is which is the soft tissue in the area of the intended lesion affected by nitric oxide.

This prevents destruction of the soft tissues in those cases where there is a significant risk of their occurrence, namely in elderly or debilitated patients, and in extreme conditions, with radiation or chemotherapeutic treatment of cancer patients.

For the prevention of postoperative complications by nitric oxide can affect the surgery area in the preoperative and/or intraoperative and/or postoperative periods.

This makes it possible to enhance microcirculation and metabolism in the soft tissues in the area of operation and thus prevent various complications of wound healing: of wound infection, dehiscence, fistula formation, etc.

Radiation therapy with nitric oxide, it is advisable to affect the soft tissue in the area of the exposure before and/or after each session of radiotherapy.

This ensures the prevention of damage to the skin and underlying tissue with radiation therapy in cancer patients: radiation dermatitis, radiation trophic ulcers, radiation fibrosis of soft tissues.

For prevention the Agen cloth before applying a medical dressing. This allows for military operations, disaster medicine, accidents, etc. to prevent suppurative and necrotic complications of fire, hurt, stab and other wounds, burns and other traumatic pathology.

One of the significant achievements of biology and medicine of the last decade was the discovery of the properties of the molecule nitric oxide (NO) formed in the body from amino acids L-arginine by the enzyme NO-synthase. Known important role of endogenous NO as polyfunctional regulator (the"new signal molecules", "second messenger"). Adjusting guanilatziklazy and other cellular and tissue mechanisms of NO in normal and especially in terms of pathology has a significant effect on vasodilation, prevents intravascular platelet aggregation and blood clotting (anti-platelet effect) affects the regulation of respiration, immune status of the organism, the activity of macrophages, the expression of genes, conduction of nerve impulses, etc.

Patent-pending method for the treatment and prevention of destructive, inflammatory and sclerotic lesions in soft tissues is that for the first time in medical practice on the affected skin, muscle, or the who. the. coming from outside, by nitric oxide. It is advisable to influence the nitric oxide directly for direct delivery of gaseous NO in the affected tissue of the body.

The affected tissues in the treatment of wounds, burns, trophic skin ulcers and pressure ulcers, erosive and ulcerative lesions of the mucous membrane of the oral cavity, inflammatory and fibrotic diseases of the skin, muscle tissue, joints, inflammatory-erosive processes in the mucous membrane of the vagina and cervix can be affected in a gas stream containing nitric oxide, obtained, for example, by passing air through an electric discharge.

When passing a stream of atmospheric air through almost any electrical discharge therein due to the high temperature leads to the formation of NO from nitrogen and oxygen in accordance with reversible chemical reaction accompanied by the absorption of large quantities of heat:

N2+ O2<------> 2NO - to 43.2 kcal

The shift in the equilibrium of this reaction to the right is due to the rapid cooling of the gas mixture after passing through the electric discharge, as a result, (i.e., rapid cooling - quenching) the equilibrium does not have time to immediately shift to the left, and is by almost the same amount NO formed at a high temperature.

The classical way of obtaining is NO way of passing air through an electric discharge (electric arc) continuous current, implemented in two - or three-electrode plasma devices, called plasma torches (thermally equilibrium plasma-chemical technology).

Flowing out of the device, the gas flow in a state of low-temperature plasma at a temperature of 3000 - 4000 K, in the immediate vicinity of the outlet can contain up to 5% NO. Therapeutic effects of exercise peripheral region of the gas stream, a remote (10 - 20 cm) from the outlet of the device, with a temperature of 20 - 45oC in fact, due to the expansion of the flow in the environment, the content of nitric oxide in amounts of 0.03 to 0.15% (concentration - 400-2000 mg/m3).

An alternative method of producing nitric oxide from atmospheric air is thermally non-equilibrium plasma-chemical technology, in which the air flow is passed through an electrical discharge excited by a high-frequency current. An example of such a method can be odnoelektrodnogo flare discharge, implemented p is a consequence of thermal nonequilibrium temperature gas flow (~ 100oC) and the concentration of nitric oxide (~ 50 mg/m3the output device is far below these figures with thermally equilibrium technology, therapeutic effect occurs when distances within ~ 10 mm from the outlet of the plasma torch.

The described devices are essentially air-plasma generators of nitric oxide.

Experimental study of the effects of the air flow containing NO obtained by equilibrium plasma-chemical technology, held at 80 white rats with models conditionally aseptic and infected wounds of the skin, gave the following results.

In the first series of experiments in the edges of the skin wound size 300 mm2stuck closed top film rings to prevent the formation of a scab. After 1, 3 and 4 days after surgery, the wounds were exposed to chilled air plasma stream at a distance of 20 cm from the outlet of the plasma torch (temperature 42oC, NO concentration is 400 mg/m3). In the control group the intervention was carried out by flow of heated heat of air with similar temperature and dynamic pressure of the gas, but does not contain NO. After 4 days the ring with the systematic study of wound tissues.

In the experimental animals macroscopically significantly faster starred inflammation, decreased the amount of wound exudate, the wound quickly reduced in size; 40% of the animals in the control group occurred infection and suppuration, in the experimental group suppuration was absent. The sizes of the wounds in the experimental group (excluding festering wounds in the control group) for 10 days was accounted for 95.2 6.1 mm2(in the control 158,8 10,6), 14 day - 56,9 of 3.42 mm2(in the control 97,4 7,2), on the 18 day of 34.6 1,82 mm2(in the control 60,6 5,7), at 21 days and 21.8 2.6 mm2(in the control 34,9 1,6), on the 24 day - 5,7 0,6 mm2(control of 18.5 to 1.6). The final healing in experimental rats increased compared with the control 24.8% excluding festering wounds.

Morphological studies using histochemical methods showed that when exposed to NO in the wound was absent microflora, declining febrina exudation, edema, neutrophil infiltration, and other manifestations of impaired vascular permeability. Significantly shortened the inflammatory phase of wound healing and accelerated reparative phase: the proliferation of fibroblasts, tumor vessels, growth and maturation of granulation tissue. NO also carried out stim animals much faster reductions wound through the development of Mature fibrous tissue (contraction) and by regional regeneration of the epithelium.

Especially pronounced was the stimulation process of wound healing in the second series of experiments, which used a similar experimental model, but with infected wounds Staphylococcus aureus (1 billion microbial cells). The wound took a purulent character, but when exposed to NO purulent exudate decreased much faster and the wound was cleaned to 3-4 days (in the control and in some animals, to 10 days). Microbiological examination of smears from the surface of the wound showed that in the experimental group the severity of microbial colonization was significantly decreased, indicating that the bactericidal and bacteriostatic action NO. Morphological study revealed that NO significantly normalizes impaired microcirculation in the tissues of the wound: disappears sludge phenomenon (the agglutination of red blood cells), intravascular aggregation of platelets and leukocytes, microthrombus, increased microvascular permeability, reduces edema and inflammatory neutrophilic infiltration, phagocytosis of microbes by macrophages. On the 10th day, when the control was still dominated by purulent inflammation of the bottom of the wound and there was practically no granulation tissue in the experimental group noted the pronounced development of the latter. In postelnoe healing was accelerated by 26.4%.

When therapeutic treatment of patients with therapeutic effects, it is advisable to carry out peripheral region of the gas stream, remote 15-25 cm from the outlet of the device, with the corresponding temperature from 30 to 45oC. Criterion the distance of the object (skin, mucous membranes, wounds, and so on) from the outlet of the device is the lack of pain response of the patient. Time impact on the affected tissue, i.e., the duration, and the scanning speed of the beam of the gas stream (light stains on the fabric), the number of treatment sessions and their frequency set based on the form and stage of the pathological process, the intensity and depth of the lesion, treatment, and other factors.

For therapeutic treatment of diseased tissues by exposure to a stream of gas containing NO, for example, when wound pathology, the patient is placed in a treatment or dressing room standing, sitting or lying down depending on the localization of the wound defect and physical condition of the patient. Remove the bandage covering the wound, the doctor includes a source of air-plasma flow, which is in his hand, and affects wound powerhouses.these the influence of NO-containing stream on the wound until light yellow, opal film and lack of wound exudate. The impact of spending on clean from drugs, ointments, bandages surface; binding the capture zone of influence of the gas flow around, not visually affected tissues; in the wound should be no bleeding and massive necrobiotic changes. After treatment, the wound is closed with a sterile gauze bandage or leave open. The number of treatment sessions and duration of each session is set depending on the area of the wound, its phase and other conditions.

Here are clinical exemplary embodiment of the claimed method of treatment of chronic wounds with NO impact-containing plasmadynamics stream.

Patient P-th A. M., 1929, R., N history MS-428.

He entered the Moscow research oncological Institute. P. A. Gertsen 24.10.97, with a diagnosis of Malignant histiocytoma left scapular region IV stage. Condition after extensive excision tumor soft tissue of the back with resection of the scapula bones, closure of the defect displaced flaps, flap necrosis. Condition after postoperative radiation therapy.

Admission: on the surface of the syrup region, dimensions 18 x 14 cm, on the background and postoperative and postradiation fibrosis-affected tissues. The bottom of the wound unevenly covered with pale granulation, epithelization process is not expressed.

The patient began a course plasmadynamics NO-therapy by direct exposure to a gas stream containing nitric oxide, on the wound and surrounding tissue. The exposure was conducted at a distance 17-22 cm from the outlet of the device within 2-4 minutes each day. Medication were excluded. 4-5 sessions marked the emergence of an active, rich granulation tissue across the surface of the wound, islet and marginal epithelization. It also revealed a reduction in pain sensitivity, reducing the size of the wound. Full closure of extensive soft tissue defect was achieved on 18 - 20 sessions by secondary tension due to the concentric contraction of the wound defect, marginal and insular epithelialization, reduced the severity of vibrationaly surrounding tissues.

Given the high penetration ability of the molecule NO, it's advisable to plasmadynamics NO therapy for the treatment of such inflammatory and sclerotic diseases of soft tissues, such as acute and chronic postlicensing Genesis. The mode and duration of treatment, frequency of sessions and duration of treatment depend on the form and stage of disease, effectiveness of treatment.

Here is a clinical example of the method of treatment of lesions of soft tissue araneosa character.

Sick And and So M, 1954 R., N history MS-264.

He entered the Moscow research oncological Institute. P. A. Gertsen 22.12.97 was diagnosed with a Pronounced postradiation fibrosis of the soft tissues of the anterior abdominal wall, buttocks, or groin. Lymphedema of the lower extremities. Pain syndrome.

Previously (1996-1997 gg) patients received chemoradiation therapy for cancer of the cervix, stage IV (squamous cell carcinoma).

Admission: the soft tissue of the lower half of the anterior abdominal wall from the navel to the pubis with the transition to lateral, inguinal folds and right gluteal region presents fibrous altered conglomerate solid "rocky" texture, uneven in length, not very sensitive, but painful to palpation of the skin. About these complications, the patient was carried out repeated courses of drug therapy (compresses, ointments and other) without the t pain syndrome.

Patients received a course plasmadynamics NO-therapy according to the following procedure: remote impact at a distance of 15-20 cm for 10 s on a single zone (the beam diameter 3 cm), the total exposure time of 1.5 minutes there were two courses of treatment for 10 sessions daily with an interval of 14 days.

A significant improvement: the severity of vibrationaly much reduced by palpation and according to sonography, fabrics are soft, some areas little distinctive from healthy, normal skin pigmentation, restored the sensitivity, the pain is almost absent. Subjective - a sharp decline unease.

The patient is examined after 2 to 3 weeks after completion of the course. At the same time revealed a prolongation of the effect of NO-therapy in increasing subjective and objective positive symptoms treatment.

Good clinical effect in this case is achieved due to the fact that NO acting on the microcirculation, tissue metabolism and nervous trophism of soft tissues, contributed, as shown by histological examination, reduction of dense edema, reverse the development of excessive connective tissue in the dermis, subcutaneous tissue, and muscle tissue. Similar obeling scars.

Plasmadynamics gas stream containing nitric oxide, can also be used for the treatment of oral mucosal diseases, such as periodontal disease, erosive-ulcerative and ulcerative-necrotic lesions of the mucous membrane of the mouth, tongue, and gums of the teeth with postradiation or herpetic stomatitis, chronic Autonom stomatitis, erosive-ulcerative lesions of the lichen planus, multiform exudative erythema, necrotic lesions gingivo-Vincent stomatitis and other diseases of the oral mucosa.

To do this, on the mucous membrane of the mouth, gums and tongue in the area of the lesions affect gas stream containing NO at a temperature of 38 - 42oC for 15 - 20 seconds on one affected area. Temperature and total duration of exposure, frequency, and number of impacts depend on the form of the disease, the prevalence of pathological process, its stages, treatment, sensitivity of individual patients, and other factors. This energy can enter into the complex of other traditional treatments. The impact of NO increases the efficiency of complex treatment reduces the duration of treatment, sposobstvo etc.

Similarly, a gas stream containing nitric oxide, you can affect the mucous membrane of the vagina and cervix with their inflammatory-erosive diseases such as erosive colpitis and vaginitis. The temperature of the gas stream, the duration of exposure and General treatment, frequency of exposure depend on the stage and form of the disease, the distribution process, the sensitivity and age of patients and other factors.

In addition, the effect of the nitric oxide contained in plasmadynamics the gas stream may be used for inflammatory skin diseases such as erysipelas, streptoderma and other pustular diseases, exudative diathesis, psoriasis, some forms of eczema and dermatitis and other diseases in case of intolerance of antibiotics and hormones, as well as in cases that do not respond to traditional therapy.

The effects of NO in these cases leads to a bactericidal effect and to reduce infection in the skin, a significant reduction of inflammatory manifestations and skin itching, eliminating pathologic process, and extended periods of remission in chronic diseases.

There are several ways to obtain the NO of chemically pure substances. NO it is convenient to obtain, for example, by the interaction of metallic copper with dilute nitric acid:

3 C satellite + 8HNO3= 3 C satellite(NO3)2+ 2NO + 4H2O.

For cleaning from higher oxides of nitrogen (nitrogen dioxide NO2, camerahouse nitrogen (N2O4and others ) and spray nitric acid obtained NO pass through a 5% solution of sodium hydroxide NaOH and collect above the solution. If necessary, the nitric oxide is dried, passing through the tube with solid potassium hydroxide KOH.

Also available way receipt NO is prelivanje 40%-aqueous solution of sodium nitride NaNO2to 30% of the resultant solution of ferric chloride FeCl2(or 20% of the resultant solution of ferric sulfate FeSO4), mixed with an equal volume of hydrochloric acid HCl (density 1.19 g/cm3):

FeCl2+ NaNO2+ 2HCl = FeCl3+ NaCl +NO + H2O

Eye-catching NO clean, running it through a 10% solution of sodium hydroxide NaOH.

For further medical use obtained in the ways described NO need to mix with inactive, not containing oxygen gases the implementation of therapeutic effects resulting mixture through a system of reduction and flow control for flexible tubes with the respective nozzles are directed at an ambient temperature on the affected biological tissue.

Use for the treatment process, nitrous oxide, are mixed with inactive gases in pressure vessels, it is advisable to apply in stationary medical institutions.

For use in extreme conditions, for example at the stage of pre-hospital care for gunshot wounds, disaster medicine, and so on, you can use a chemical reaction receipt of nitric oxide by heating a mixture of potassium nitride KNO2, potassium nitrate KNO3and chromium oxide Cr2O3:

3KNO2+KNO3+ Cr2O3= 2K2CrO4+ 4NO.

This mixture may be included in tablets containing (in weight percent) 22% KNO2, 9% KNO3, 27% Cr2O3and 42% of iron oxide Fe2O3which , being in a special container, when heated, for example by catalytic heat source, emit a gas containing efficiency of 99.78% nitrous oxide, and 10 g of these pellets obtained 860 - 870 ml of gas. The container can be filled with an inactive gas such as nitrogen, and equipped with a hand valve, by opening which the mixture of nitric oxide and nitrogen sent to the affected biological tissue.

The gas stream containing nitric oxide, receive the stream, contains NO obtained by passing air through an electric discharge. Gas stream impinges directly on the affected tissue. The method and duration of individual exposure, frequency of sessions of exposure, the total duration of treatment, as in the first case, depend on the form and stage of the disease, size and depth of the lesion, the rate of formation of granulation tissue, cleansing and epithelization of the defect, reduction of inflammatory or sclerotic process in the soft tissues.

For the first time in medical practice for the treatment of slow-healing wounds and ulcers, inflammatory and destructive inflammatory diseases of the skin and mucous membranes on the surface of the affected affected azotosodyerzhascimi medicinal substances that metabolize in the body of the patient secrete nitric oxide: sodium nitroprusside, nitroglycerin, N-nitropyrazole, 5-nitrosoglutathione, nitrosomonas metals and other nitrocompounds.

These medicinal substances can be used in the form of a spray when spraying the wound surface of the skin, inflammatory skin lesions, inhalations with lesions of the mucous membrane of the oral cavity, in the form of gels and patches, is esta used in quantities sufficient to achieve a therapeutic effect: healing wounds and ulcers, edema and inflammatory processes. The dose and the interval between drug administration set depending on nosological forms of diseases, lesion volume, duration and stage of disease, speed healing and individual tolerance patient medications.

Here is a clinical example of the use of inhalation of nitro compounds in the treatment of stomatitis.

Patient W-H. A., 1943, R., N history of EA-827.

Received of Moscow in them. P. A. Gertsen 28.01.98 was diagnosed with Cancer of the mucous membrane of the bottom of the oral cavity stage IV (squamous cell variant), metastases in the lymph nodes of the neck.

On the background of preoperative radiation therapy, the patient developed complications in the form of early radiation stomatitis, therefore, was discontinued radiotherapy and the patient began a course of inhalation therapy of nitroglycerin on the mucous membrane of the oral cavity. The exposure was carried out two times a day from a distance of 7 cm from the damaged surface by means of spraying of the drug Nitrolinqual-Pumpspray containing nitroglycerin. After 7 sessions of treatment with nitroglycerin, the patient is much less clinically the tion.

Thus, nitric oxide or exogenous origin in the form of a gas stream, or standing out in the tissues of medicinal substances, has a pronounced therapeutic effect by normalizing the disturbed microcirculation of blood in the affected tissues, activation of macrophages, phagocytosis of bacteria and production of cytokines that regulate the growth of fibroblasts. While NO increases the proliferation of fibroblasts and synthesis of DNA, RNA and proteins of the extracellular matrix, which is shown in cell culture (fibroblasts).

The use of NO for the treatment of the affected soft tissue significantly reduces inflammatory infiltration of the tissues, normalizes immune reactions, strengthens regeneration of connective tissue and epithelium, dramatically accelerates the healing of tissue defects (wounds, ulcers, burns and other) and the elimination of the inflammatory and sclerotic processes in soft tissues. The stimulation conduction of nerve impulses, i.e. not only improves vascular, and nervous tissue tropism, which further leads to increased tissue regeneration, elimination of inflammation and resorption of sclerotic changes.

To ensure dolgozhivuscikh wounds and trophic ulcers of lower extremities in diabetes, atheroscl the m of the methods mentioned above, not only on the wound surface, but also on the overlying intact region of the legs to increase blood flow and nerve conduction, i.e., to improve the cardiovascular and nervous trophism in affected areas, which greatly improves the results of treatment.

Here are clinical example.

Patient P in C. A., 1929, R., N history of EA-97.

Received of Moscow in them. P. A. Gertsen 07.01.98, with a diagnosis of Occlusive disease of lower extremities vessels, occlusion of the iliac-femoral artery, condition after implantation of these vessels, diabetes, trophic ulcer of the left tibia.

Objective: the limbs, especially the feet, cold to the touch, hyperpigmentation on separate sites, positive symptom "plantar" ischemia, barely captured the pulse of the dorsal arteries of the feet. On the lateral surface of the lower third of the left tibia ulcer up to 2 cm2. The ultrasonic Doppler blood flow in the vessels of the lower leg is not defined.

Conducted a session plasmadynamics NO-therapy by targeting the area ulcers and in the course of the main vessels of the leg. Control Doppler sonography showed a distinct pulsation of the arteries of the leg and improve techeniya plasmadynamics NO therapy daily. As a result, after 10 days of elimination has been achieved trophic ulcers, normalization of skin pigmentation, increased skin temperature of the extremities, improved ripple in the back of the arteries of both feet.

Similarly it is possible to treat occlusive disease and other diseases with impairment of the arterial blood supply to the extremities and without ulcerative lesions of the latter.

The claimed method can be successfully used for transplants autologous skin or skin-muscle flap for extensive or non-healing wound surface, resulting from burns, major surgery, trauma, venous ulcers or other reasons. In this case it is more convenient to use a gas stream containing NO obtained by passing air through an electric discharge or by chemical means.

Gas stream advisable affect the skin of the donor area in the field taking a skin graft or small areas of the skin for 4-6 days before transplanting daily one session of exposure. The exposure time is determined by the size of the flap. The purpose of impact is to stimulate microcirculation and metabolism in the donor area. About to accelerate the development of granulation and preparation autodermoplastiki. After autoplasty the transplanted flap gas stream containing NO impact daily for 3-6 days depending on the size of the wound to speed healing and prevent rejection of the transplanted graft. At the same time, it is advisable gas stream containing NO impact on the donor wound, thus speeding up its healing.

For the first time in medical practice for the treatment of acute and chronic inflammatory, destructive inflammatory and ulcerative processes in the mucous membranes of internal organs of the gas stream containing nitric oxide, obtained by any of the above ways, affected by endoscopic devices. For example, for the treatment of erosive gastritis or chronic gastric ulcer and 12 duodenal ulcer the gas flow is directed to the mucous membrane of the stomach or intestine through the gastroscope. Gas containing NO, obtained by chemical means, can also be directed through the thick probe.

In the treatment of inflammatory processes in the larynx, trachea and bronchi gas stream containing nitric oxide, refer to the mucous membrane through a laryngoscope or bronchoscope. In the treatment of inflammatory and inflammatory-destructive zabolevanija channel through the cystoscope. However due to the high permeability of nitric oxide, you can implement a therapeutic effect on the prostate gland with such a common disease, such as prostate.

Dosage NO, the duration and frequency of sessions of exposure, the duration of treatment in all of these diseases depends on the stage and form of the disease, the sensitivity of the patient to the effects of NO, age, treatment effectiveness and other nosological, topical and individual factors.

Similarly to the affected surface of the serous membrane of the abdominal cavity, such as peritonitis or other diseases, as well as serous membranes pleural cavities, for example, when pleurisy for the treatment of inflammatory processes can be affected by the gas stream containing nitric oxide, through the laparoscope, thoracoscope or drainage tube. Possible exposure to a gas stream containing NO through endoscopic devices on the internal organs of the abdominal cavity (liver, pancreas, gallbladder and other ) pancreatitis, cholecystitis and other diseases. Dose and duration of treatment is determined by the nature of inflammation (serous, purulent), intensity and phase of the process, and TDS the treatment of acute and chronic synovitis, for example in rheumatoid arthritis and other joint diseases. The gas flow may be directed through the arthroscope or puncture needle into the joint cavity, but also, given the permeability of NO, on the skin of the affected joint.

For the first time in medical practice for the prevention of suppurative complications of wound healing, dehiscence, fistula formation, etc. in the preoperative period in patients with high risk of complications (weakened, cancer, immune disorders and other) on the skin in the area of operations influence the gas stream containing NO received one of the methods mentioned above. This impact exercise daily for 3-4 days before surgery (1 session per day) and then continue after surgery (up to 3-4 days) in the operational area of the joint.

In addition, in the newly developed method can be used to prevent skin lesions radiation therapy (radiation dermatitis, radiation ulcers). To do this, before and/or after each session of radiotherapy on skin in the irradiated region is affected plasmadynamics gas stream containing nitric oxide, or NO, obtained by any of the methods mentioned above.

As an example, the effectiveness of such Tr> Received of Moscow in them. P. A. Gertsen 02.10.97 was diagnosed with cancer of the right mammary gland III B stage. Condition after radical mastectomy for Madeno. In terms of combined treatment the patient is shown the course of postoperative radiation therapy. To prevent radiation reactions prophylactically course started plasmadynamics NO therapy, covering the entire surface of the skin in the area of radiation capture the surrounding tissue up to 3 cm from the border exposure. Plasmadynamics therapy was carried out in 0.5 hours after each session of radiotherapy (total of 20 sessions of exposure daily).

As a result of this combined radiation therapy and NO-therapy conducted a full course of therapy as prescribed scheme and the planned dose, what has been done only because of the lack of development of radiation reactions in the zone of irradiation.

Conclusion. Achieved full clinical effect of preventing the development of early radiation reactions with NO therapy.

In order to prevent complications (e.g., abscesses and other) with lesions of soft tissues, such as firearms, hurt, stab and other types of wounds, traumatic pathology, burn disease, and other conditions of disaster medicine and military to the ery once before applying the medical bandage on the stage of providing pre-hospital care.

From the above it follows that for the first time in the domestic and the world created by the method of exogenous and endogenous NO therapy and NO-prophylaxis of a variety of traumatic, destructive, inflammatory and sclerotic lesions of the soft tissues of the body for many diseases by exposure to nitric oxide.

The treatment according to the present method is easily combined with any other types of therapeutic or surgical treatment. To undoubted advantages of the proposed method of treatment is its simplicity, affordability, versatility, painless, atraumatic, the possibility of inpatient and outpatient treatment, saving medicines and dressing material.

1. A method of treatment of lesions of the soft tissues of the body, characterized in that the affected tissue is affected by nitric oxide.

2. The method according to p. 1, characterized in that the affected tissue by nitric oxide effect directly.

3. The method according to p. 2, characterized in that the affected tissue is affected by the gas stream containing nitric oxide, obtained by passing air through an electric discharge.

4. When received by chemical reactions.

5. The method according to p. 1, characterized in that the tissue affected by nitrogen-containing medicines, generating nitric oxide in the affected tissue.

6. The method according to PP.3 to 5, characterized in that the nitric oxide effect on diseased tissue and unaffected tissue located along the main vessel, which is the blood supply to the affected tissue.

7. The method according to p. 2, characterized in that during the transplantation of a graft of tissue by nitric oxide pre-impact on the donor site and the affected tissue, and then transplanted flap.

8. The method according to PP.3 and 4, characterized in that the tissue of the mucous membrane of the internal organs, serous or synovial membranes of the nitric oxide effect through endoscopic devices.

9. The way to prevent lesions in soft tissue, characterized in that the soft tissue in the area of the intended lesion affected by nitric oxide.

10. The way to prevent under item 9, characterized in that for the prevention of postoperative complications by nitric oxide effect on soft tissue in the area of surgical intervention, kooperaciisa fact, for prevention of lesions of soft tissues during radiation therapy with nitric oxide affect the soft tissue in the area of the exposure before and/or after each session of radiotherapy.

12. The way to prevent under item 9, characterized in that for the prevention of posttraumatic complications in extreme conditions, the nitric oxide effect on diseased tissue before applying a medical dressing.

 

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2 cl, 2 ex

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