The method of treatment of acute suppurative obstructive pyelonephritis in combination with metabolic x-syndrome

 

(57) Abstract:

The invention relates to medicine, namely to urology, and for the treatment of patients with acute purulent obstructive pyelonephritis in combination with metabolic X-syndrome. To do this, after removing the obstruction in the postoperative period in a standard treatment regimen was added antihypoxic drug "lipoxen". The drug is administered in the first 14 days of the postoperative period by intravenous injection of 2 ml of a 7% aqueous solution of 400 ml of isotonic sodium chloride 2 times a day, then in tablets of 0.5 g 3 times a day for 10 days. Using the proposed method can significantly improve clinical and immunological parameters, to reduce the time the reaction temperature, pyuria, reduce functional failure of the kidneys.

The invention relates to medicine, namely to urology.

Traditional treatment of acute suppurative obstructive pyelonephritis in combination with metabolic X-syndrome is in the operational manual (Troubleshooting obstruction of the upper urinary tract, decapsulate the kidneys, the opening and drainage of purulent foci, abdominal drainage system paccom period priority of treatment is to combat infectious factor, endogenous intoxication, hypercoagulation, anemia, acidosis, immune deficiencies, activation of lipid peroxidation. For this purpose we conduct a massive antibacterial therapy, infusion-detoxification therapy, applied anticoagulants, disaggregants, immunomodulators, inhibitors of proteases (Lopatkin N.A. Manual of urology. - M., 1998).

However, the modern approach to treatment of acute suppurative obstructive pyelonephritis, which aims to eliminate the obstruction of the urinary tract, the appointment of postoperative antibiotics, infusion detoxification therapy, immunomodulators, anti - (Lopatkin N.A. Manual of urology. - M., 1998.) does not take into account the fact that the combination of acute suppurative obstructive pyelonephritis with metabolic X-syndrome, which is characterized by excess body weight, hypertension, hyperglycemia (Ginzburg, M. M., Catupecu, S., 1997, Michuk E. Yu, 1997), a significant suppression of the immune system and impaired homeostasis (Scars Y. S., 1990, Kravtsov, T. J. 1994), weight for purulent-destructive process. The usual treatment also does not take into account the peculiarities of pathogenesis of acute purulent obstructive is purulent obstructive pyelonephritis in combination with diabetes suggests along with correction of hyperglycemia using immunomodulating drugs (Antsiferov M B. , E. Surkov Century, Mayorov, A. Y. 1994, Kravtsov, T. J. 1994), however, in the literature there are no instructions on the application in the postoperative period in patients with acute purulent obstructive pyelonephritis drugs with properties antihypoxants.

The purpose of the invention: improving the treatment of patients with purulent obstructive pyelonephritis with X-syndrome.

This goal is achieved by the use of antihypoxic drug "lipoxen", which is an antioxidant and antihypoxic drug at a dose of 2 ml of a 7% aqueous solution of 400 ml of isotonic sodium chloride 2 times a day, then in tablets of 0.5 g 3 times a day, a course of 10 days.

Example. Patient Prilutsky,, 36 years old, weight 100 kg, height 165 cm, body mass index 36,7. History 117. Was hospitalized in urology Department of the Regional hospital 1, Belgorod with 13.01.2000 on 18.02 2000 for 36 days with a diagnosis of ICD. Multiple stones in the left kidney. Pyelonephritis, Pioneros, paranephric left. Urosepsis. Diabetes.

During the examination at the time of receipt by ultrasonography and radiography revealed purulent-destructive process in the left kidney, anemia (er. 2,81012/l, HB 76 g/l, Col. pok. to 0.8). L. 9,2109/l; T-helpers 24%, the absolute number 0,21109/l; T-suppressor 16%, the absolute number 0,14109/l; TX/TC of 1.5. Phagocytic activity after 30 min 28%, after 60 min of 55%.

Identified hyperazotemia (urea of 19.5 mmol/l, creatinine 306 μmol/l), Hypo - and dysproteinemia, hypercoagulation (PTI 100%).

14.01.2000 produced nephrectomy on the left.

In the postoperative period the patient received conventional treatment + lipoxen 2 ml of 7% aqueous solution of 400 ml of isotonic sodium chloride/drip 2 times a day for two weeks, then in tablets of 0.5 g 3 times a day for 10 days. Body temperature was normalized to 7 days of postoperative period (the control group at 14 days), immunological indicators to 7 days in the control group to 11,5 day), leukocyte reaction - to 8 days in the control group to 12 days), indicators of red blood - to 6 days in the control group to 10 days), hyperazotemia stoped to 5 days in the control group to 7 days), the indices of coagulation normalized to the 4th day of the postoperative period in the control group to 8 days). Discharged 18.02.2000 with recovery. The postoperative period was 35-bed d is s results. Managed to achieve more pronounced immunomodulatory, antioxidant, detoxification and anticoagulant effect, which reduced the average duration of the postoperative period to 33.7 bed days compared with the control group (39,3 bed-days).

The method of treatment of acute suppurative obstructive pyelonephritis in combination with metabolic X-syndrome, including the appointment of postoperative traditional therapy, characterized in that it further impose lipoxen at a dose of 2 ml of a 7% aqueous solution of 400 ml of isotonic sodium chloride 2 times a day for 14 days followed by a reception of lipoxen in tablets of 0.5 g 3 times a day, a course of 10 days.

 

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in which R1' has the abovementioned meaning and M represents a hydrogen atom or the radical R2' which has the values specified above for R2in which the possible reactive functions can be protected by a protective group, is subjected to reaction with the compound of the formula (VIII) defined above, to obtain a product of formula (X):

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in which R1' M and R4' have the above values, the obtained compound of formula (X), if M implies R2' defined above, is subjected to a halogenation reaction, to obtain the product of formula (XI):

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in which R1', R2', R4' and Hal have the above values, which is subjected to the reaction of the exchange of the halogen-metal, then the reaction with the compound of the formula (XII):

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in which R9' matter referred to in paragraph 1 for R9where possible reaction ф�g/rupat4/200110/01/2174513-36t.gif" ALIGN="ABSMIDDLE">< / BR>
in which R1', R2', R4' and R9' have the above meanings and, if necessary, or interact product of formula (I2) with the compound of the formula (XV):

O=C=N-R6' (XV)

in which R6' matter referred to in paragraph 1 for R6in which the possible reactive functions can be protected by a protective group, to obtain a product of formula (I3):

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in which R1', R2', R4' and R9' have the above meanings, or the product of formula (X), provided that M denotes a hydrogen atom, is subjected to a halogenation reaction to obtain a product of formula (XIV):

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a) esterification of the acid function,

(b) saponification functions of ester to acid functions,

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m) the transformation function sulfide, sulfoxide or sulfone function corresponding sulfoximine,

n) the transformation function oxo function of thioxo,

a) transforming radical

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in radical

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p) conversion of the acid function in function

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q) is the transformation function of beta-keto-sulfoxide in the function of alpha-ketotioefir,

r) the conversion of carbamate into urea and, in particular, sulfonylamino in the sulfonylurea,

s) removal of protective groups, which can protect the reaction functions,

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