Treatment of bilateral tumor pleurisy
The invention relates to medicine, namely to Oncology, and can be used for the treatment of generalized neoplastic process with bilateral metastatic pleural effusion. The method includes the maximum evacuation of the pleural effusion, 20 ml is used for dissolution of cytostatic dose, incubated at t=37oC for 30 min and injected vnutriplevralno, the action is repeated on the opposite side. The method improves the effectiveness of treatment through the use of modifying properties of proteins pleural fluid, provides low toxicity of chemotherapy and low cost treatment. 2 Il. The invention relates to medicine, namely to Oncology, and can be used for the treatment of generalized neoplastic process with bilateral metastatic pleural effusion.There is a method of treatment of neoplastic pleural effusion (C. M. Moiseenko, V. F. Semiglazov, S. A. Tulandi. Modern drug treatment of locally advanced and metastatic breast cancer. - SPb, 1997, S. 205-207), including pleurodesis or puncture of the pleural cavity and the introduction of sclerosing substances, most often of which use of bleomycin, telescope pleurisy with subsequent obliteration of the pleural cavity. The procedure should be repeated every other day not less than 3 times regardless of the amount of fluid in the pleural cavity.However, this method has the following disadvantages: the operation pleurodesis is invasive and involves thoracostomy and introduction into the pleural cavity of the catheter connection system with negative pressure for a few hours; if insufflate talc expected thoracoscopy with General anesthesia and, finally, a number of complications associated with the use of themselves sclerosing drugs - for example, "armor light" in the application of tetracycline, severe inflammatory reaction with heavy exudation of fibrin in the application of Corynebacterium parvum, fever and chest pain when applying bleomitsetina, etc. however, in 10% of patients with exudative pleurisy is bilateral, accompanied by phenomena pulmonary-cardiac insufficiency, combined with the overall poor condition of patients, which limits the application of the proposed method of treatment.Known "Method of chemotherapy for ovarian cancer stage III-IV (Patent of the Russian Federation 2056839 from 27.03.96. Bull. 9, ed. Sidorenko, Y. S.), chosen as a prototype, which is that the dose rate antitumor himmeiweit for 4 hours in a water bath at t=37,0oC, and then re-injected into the abdominal cavity of the patient. This method eliminates General toxic effects on the body, stops the accumulation of ascitic fluid, reduces the size of the tumor increases interoperability.However, this method cannot be applied for the treatment of neoplastic pleural effusion due to the use of ascitic fluid, in addition, continuous incubation of chemotherapy. With the introduction of chemotherapy in the pleura is necessary to avoid additional amounts of liquid, especially when bilateral process of neoplastic pleural effusion.The aim of the invention is to increase the efficiency of treatment of patients with bilateral tumor pleurisy.This objective is achieved in that the patient most evacuate the pleural effusion, 20 ml is used for dissolution of cytostatic dose, incubated at t=37oC for 30 minutes and enter vnutriplevralno, the action is repeated on the opposite side.The invention of "a Method for the treatment of bilateral tumor pleurisy is new, because it is unknown the level of medicine in the field of drug therapy in Oncology.The novelty of the invention lies in the fact that patients under local produce for dissolution of cytostatic dose, incubated at t=37oC for 30 minutes and enter vnutriplevralno, the action is repeated on the opposite side.One of the principal differences between this method of treatment used so far in Oncology is the use for intrapleural administration of cytostatic pleural effusion, which was first used as biorestoration cytotoxic drugs for their intrapleural injection. It is known that the pleural fluid is a protein environment, which is not alien to intrapleural injection. With a massive lesion of pleura significant loss of protein with effusion, which must be replaced when exposee in large volumes. So use your own pleural fluid for introduction into the pleura allows you to compensate for these losses. Dissolution in the pleural fluid of massive doses of chemotherapy eliminates the introduction of tumor cells in the pleura, as it causes their death. Occurring during the incubation connection cytostatic protein pleural fluid in the complexes allows you to Deposit them in the pleural cavity, which causes their tumorotropic and tumoricidal action. Autoinvoice allow IP the BA is also possible with unilateral malignant pleural effusion. Using this method eliminates the toxicity of the treatment and allows you to combine it if necessary with standard chemotherapy.The invention is industrially applicable and can be used in health care, the medical institutions for the treatment of malignant tumors, Oncology, oncologic dispensaries."A method for the treatment of bilateral tumor pleurisy" is as follows.In a patient with bilateral tumor pleurisy under local anesthesia with 0.5% solution of novocaine in the amount of 20-40 ml produce puncture of the pleural cavity, which are actively aspiration of the liquid in the greatest possible number. 20 ml eksponirovannoi pleural fluid used to dissolve cytostatic dose and incubated in a thermostat at t=37oC for 30 minutes. Next, make the introduction of drugs into the pleural cavity. From the pleural cavity out. Carry out the same procedure with the other affected parties. If necessary, you can repeat the procedure. When the intrapleural injection of drugs on autoplasma the combination with systemic chemotherapy.The original and after the procedure carried out con the KG and x-ray studies of the chest. Observe the General condition of patients.An example of a specific implementation of the Method of treatment of neoplastic pleural effusion".Patient T. , 50, I. B. 2369/0, was on treatment in the chemotherapy unit 1 RNII with 12.02.01 on 01.03.01 with complaints of dry cough, dyspnea at rest, aggravated by movement, weakness. From the anamnesis it is established that in 1999 in the hospital, Makhachkala conducted combined treatment for cancer of the right breast stage IIA. The diagnosis was confirmed histologically ( 1631-38). The condition has worsened since December 2000, when there was a dry cough, low-grade fever. Has addressed to therapist at the place of residence, which revealed bilateral pleural effusion, pleural puncture the received cell carcinoma. The patient sent to RNII.When entering a state of moderate severity, pale skin, wet, shortness of breath up to 26 per minute conversation and movements. Thorax correct form, there is a weakening voice shaking at the lateral and lower parts of the chest, more to the left. Percutere marked blunting of pulmonary sound below the fifth rib on the right and the third rib on the left. Auscultation of breath in the lungs on both sides are heard on the left below the third rib on the right - below V ribs. The colours Nakov recurrence and metastasis regional lymph nodes are not enlarged. From other organs revealed no pathology. On FLO 153 from 12.02.01 - light without focal inflammatory changes, bilateral exudative pleurisy, more revealed the left until the fourth rib to the right until the fifth rib. Thickened Magdalena pleura on the right. The mediastinum is not displaced (Fig.1).Further clinical and instrumental examination of the data for distant metastases in other organs did not reveal.Diagnosed Generalization of cancer of the right mammary gland (radical mastectomy in VII-99, senior IIA) with metastasis to the pleura on both sides, bilateral exudative pleurisy. Gr. IV. Pulmonary heart disease I-II degree.15.02.01 the patient under local anesthesia solution of novocaine 0,5%-20,0 6 intercostal space left on signedmessage line produced pleural puncture with evacuation transparent yellow liquid in the number of 1800 ml. In 20 ml of pleural fluid was dissolved 40 mg thiotepa. After co-incubation at t=37oC for 30 minutes intrapleural administration of the drug.Cytological examination of pleural fluid 1233-36 from 15.02.01 detected cell carcinoma.16.02.01 was carried out similarly pleural puncture sprawnie 40 mg thiotepa vnutriplevralno.Both puncture passed without complications. The patient's condition has improved, disappeared cough and shortness of breath. In the lungs the breath were heard from both sides. On the control FLOW 196 from 28.02.01 dynamics showed complete resorption of fluid in the pleural cavity (Fig.2).Next, patients received 6 courses of chemotherapy.Re-accumulation of fluid in the pleural cavity were observed. Up to the present time the patient is in remission.Technical and economic efficiency "method of treatment of bilateral tumor pleurisy" is to increase the effectiveness of treatment through the use of modifying properties of proteins pleural fluid when applying chemicals in conventional doses that do not increase the cost of treatment. The method eliminates the toxicity of chemotherapy, which reduces the cost of accompanying therapy and reduces length of stay in hospital, can improve the quality of life of patients with disseminirovannam malignant process with bilateral metastatic lesion of the pleura.
ClaimsTreatment of bilateral tumor pleurisy, including aspiration of pleural fluid, otlichuy testatika dose, incubated at 37C for 30 min and injected vnutriplevralno, the action is repeated on the opposite side.
FIELD: medicine, surgery, coloproctology.
SUBSTANCE: one should introduce gelatin-based colloids: gelatinol or gelofusin and crystalloids at 1:1 ratio at total volume of 40-50 ml/kg patient's body weight daily; additionally, since the 2nd to the 7th d after operation it is necessary to conduct enteral nutrition in the form of hypercaloric mixtures by increasing their volume at higher rate of injection starting from 25 ml/h/kg body weight on the 2nd and 3d d up to 100 ml/h on the 6th-7th d. The present innovation enables to improve nutrition of intestinal endothelium, decrease pathogenic and conditionally pathogenic microflora, prevents appearance of postoperational intestinal paresis and restores its function in more shortened terms.
EFFECT: higher efficiency.
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