A method of treatment of metastases in the liver
The invention relates to medicine and can be used for the treatment of liver metastases. Under ultrasound guidance using a bipolar electrode applied to the site of lesion, conduct electrochemical lysis (ECL) metastasis DC current strength not less than 80 mA and a duration of at least 30 minutes, visualize echopositive education and the session goes cease when echopositive formation of rounded in the area of metastasis with its full coverage and capture 5-10 mm normal liver parenchyma. Treatment is considered effective when a stable size echopositive education after the ECL within 24 hours. The method allows to increase the effectiveness of the treatment of metastases in the liver. 2 Il.The invention relates to medicine and can be used in surgery, Oncology.A known method for minimally invasive treatment of liver metastases by electrochemical lysis (ECL). The essence of this method lies in the fact that the generator of direct current between two electrodes (anode and cathode) leads to the destruction (lysis) of tissues and liver metastasis with education in the area of the cathode, alkali and hydrogen, and in the area of the anode of hydrochloric acid and oxygen. Session licencing needle injected electrode, then the needle is removed. The ECL is carried out with a current of 50 mA and a duration of 30 minutes, after which the treatment area excised and subjected to microscopic examination. During the ECL is 2-stage destruction of the tumor: both due to the direct action of a constant electric current, and due to the toxic effects of alkali and acid formed during operation of the electrodes (token A. N. et al./ The scientific. conference “Current issues of diagnosis and surgical treatment of metastatic liver cancer”, M. 2001, 165-167 C.; Wemyss - Holden, S. A. et al., Clin. Sci. 2000; 98; R. 561-567; Robertson. G. S. M. et al., Br.J. Surg., 1998; 85; P. 1212-1216).The disadvantage of the proposed method is that when conducting the ECL metastases in the liver in humans control is a visual inspection of the surface zone of the liver, while the deeper layers of metastasis are evaluated only after the tumor removal surgery. I.e., non-invasive monitoring in the form of ULTRASONIC tomography for the nature of the treatment of the ECL and its results no. All this leads to a lack of clear treatment and evaluation criteria necrosis of metastasis of a non-invasive manner in the conduct of ECL in humans.The method of treatment of metastases in the liver by the ECL is that of ECL metastasis carry out the assessment necrosis of metastasis is the appearance echopositive education around the electrode, preserving stable dimensions not less than 24 hours.The mode of operation of a bipolar electrode with a current strength of not less than 80 mA and exposure time of at least 30 minutes grounded experimental research works on the liver of rabbits.Appearance echopositive zone in the projection electrode and metastasis during the ECL caused by the appearance of gas bubbles containing products lysis. During the ECL echopositive education is found in 2 types: rounded or stellate forms. Rounded shape appears during treatment and reaches its maximum size by the end of the session of the ECL. It remains unchanged for 24-30 hours, then gradually fades to 5-8 days. “Star” shape, also reaches its maximum by the end of the session, however, rapidly decreases in size (up to 50% of baseline) in 6-12 hours. This is because echopositive “spikes” of this education are tubular structures of the liver (bile ducts, portal and hepatic segmental and vnutritrekovye veins and arteries), which is filled with gas bubbles from the ECL. They quickly washed away by bile or blood, which leads to their rapid disappearance, and not a total necrosis of the surrounding tissues. Rounded ehoose, also indicate incomplete tissue necrosis. Thus, the total necrosis occurs only when echopositive the formation of a rounded shape having a constant stable size of a duration not less than 24 hours, because that is where there is a dense fabric of metastasis and liver, imperiously products electrolysis, gas bubbles and destroyed tissues from the direct effects of electric current. Exposure time is not less than 24 hours these aggressive from the point of view of impact on the whole of metastatic cells products provides reliable tissue necrosis, coincide with the boundaries echopositive education on the screen ULTRASONIC device that arise during the session of the ECL and preserving stable dimensions within 24 hours.The method is as follows. After informed consent of the patient for manipulation spend morphological verification of the identified lesions in the liver. On medical consultation to review all of the clinical and instrumental data selection circuit of the ECL. The procedure consists of 2 stages:I stage. On the screen of the ULTRASONIC device (Fig.1) by means of the sensor 1 visualize the liver 2 and metastasis 3. In the center of metastasis percutaneous enter biopsy needle 4. Then to 0 and set the parameters: the current strength of not less than 80 mA and a duration of ECL 30-45 minutes Begin the session electrochemical lysis, on the screen of the ULTRASONIC instrument visualize echopositive education 6 (Fig.2). Its diameter is 7 becomes maximum at the end of the session ECL i.e., 30-45 minutes. The session is terminated when the zone of lysis exceeds the boundaries of metastasis 5-10 mm (with capture normal liver parenchyma with the goal of ablation manipulation to prevent the dissemination of tumor cells outside the zone of treatment is a standard requirement for treatment of tumors in Oncology). When the control ultrasound after 24 hours echopositive education should be the same size as the end of a session of the ECL. Otherwise, the treatment is repeated with the direction of the electrode to the area where there has been a decrease in the size echopositive education and is determined by undamaged tissue metastasis.Example. Patient S., 54 years old, And a/B No. 1245.In the fall of 2001 was prooperirovanna in the Oncology center regarding tumor of the sigmoid colon (left-sided hemicolectomy, stage of the tumor after surgery - pT3N0M0). In February 2002 revealed a single education up to 20 mm in diameter in segment VII of the liver. For the period from February to may, 2002, the center was increased to 25 mm in diameter. It was decided to hold sessions of the ECL, because from surgical treatment of the patient from the but. In the lungs vesicular breathing, wheezing no. Heart - without features. Abdomen rounded, palpation of soft, painful during p/o scar and the point of the gall bladder, intestinal stoma in the left iliac region without features. The liver is not enlarged in size (12-8-6 cm Karlovo), the edge is soft, without features.Complete blood count: erythrocytes 3,11012/l; hemoglobin 109 g/l; CPU 0,85; leukocytes 6,4109/l; ESR 28 mm/hBiochemical blood test: whole protein 72 g/l, bilirubin 20 µmol/l, ALT 94 U/l, ACT 61 U/l, alkaline phosphatase 65 IU/L.Roentgenography of organs of gr. cells: without features.Liver ultrasound: VII segment is determined ekopozytywny hearth up to 26 mm in diameter with indistinct contours, homogeneous structure.Irigaray right fragments of the colon - relapse no.CT of the abdomen: secondary solitary change in the liver, enlargement of lymph nodes are not detected.Clinical diagnosis: Cancer of the sigmoid colon T3N0M+ (surgical treatment in 2001), the progress of the disease in the form of single metastases to the liver.Under the ULTRASOUND performed biopsy of the metastasis. Cytological conclusion: metastasis of poorly differentiated adenocarcinoma.Held h is in. At the end of the session echopositive education was 30 mm in diameter and completely covering the area of metastasis and 5 mm of the liver parenchyma around him. After a session after 24 hours, the zone of necrosis is presented in the form echopositive education, its size was stable and amounted to 30 mm. of ECL. Conducted 2 control puncture metastasis after 1 and 5 days after the session of the ECL. Fence fabric material was carried out under ULTRASOUND control of the 6 points of metastasis. Identified tissue debris, no atypical cells. Within 3 months was carried out by clinical and instrumental monitoring of the patient: the growth of the lesion was not identified, new metastatic foci is not marked.The proposed method is applied in 14 patients with metastases from various primary tumors (7-colon, 3-stomach, 2-mammary gland, 2-melanoma). All patients were operated 1-5 years ago, was held chemotherapy within the last 6-9 months, had the progress of the disease in the form of single metastases to the liver. After informed consent patients they held: 1 session 5 patients, 2 session 4 and 3 session 5 patients. The number of sessions depended on the number and size of metastases. The criterion of effectiveness of the ECL was the emergence of echopositive education in the area met the s courses of ECL remained stable for 24 hours after treatment. All patients are under medical supervision, is UZ-monitoring liver, metastasis, regional lymph nodes. Progress of the disease within 5 months of follow-up there in 10 patients. 1 patient died of intoxication (melanoma), in 2 patients there is the progress of the disease (cancerosas peritoneum), but in the area of the ECL was no relapse.Thus, the proposed method of ECL liver metastases has advantages among minimally invasive palliative treatment of this group of patients, because it is a relatively simple, low-impact, control and reproduce.
ClaimsA method of treatment of metastases in the liver, including ultrasonic testing, characterized in that by using a bipolar electrode applied to the site of lesion, conduct electrochemical lysis (ECL) metastasis DC current strength not less than 80 mA and a duration of at least 30 minutes, visualize echopositive education and the session goes cease when echopositive formation of rounded in the area of metastasis with its full coverage and capture 5-10 mm normal liver parenchyma, and the treatment is considered effective when a stable size echopositive the
SUBSTANCE: method involves carrying out transcranial micro polarizations once a week during 4-6 weeks in 15-20 min long sessions with 80-200 mcA large current over 2 electrodes. Anode is applied to the boundary of posterior region of superior temporal convolution and inferior parietal zone of the left hemisphere. The electrode is applied in later sessions to the boundary of inferior frontal region and anterior regions of superior temporal convolution and to projection of motor area of the left hemisphere cortex. The cathode is applied to the inferior regions of the left occipital area. Logopedic lessons are combined with psychological training during and between the transcranial micro polarization sessions. The treatment course is repeated when needed not more than 2-3 times a year.
EFFECT: enhanced effectiveness of treatment.
FIELD: medicine, neurology, reflexotherapy.
SUBSTANCE: the method deals with affecting biologically active points out of the following row: VB44, TR1, TR17, TR23, E1, GI20, E7, E6, E2, CI19, E4. Then comes pharmacopuncture due to applying the solution of hydrocortisone succinate. Impact should be performed with direct current through needles introduced into biologically active points.
EFFECT: shortened terms of therapy.
FIELD: medicine, surgery, surgical hepatology, intervention radiation diagnostics.
SUBSTANCE: due to ultrasound control one should introduce monopolar electrodes being parallel to the direction of vessels. Moreover, a cathode is being at the distance of 10 mm against vascular wall. Then comes electrochemical lysis (ECL) for 20 min, not more after the contact of echo-positive formation appeared during the lysis with vascular wall at the distance for not less than 1.3 against metastase diameter. The innovation enables to carry out efficient metastatic lysis near large hepatic vessels at no risk of hemorrhagic growth due to US-criteria of tissue lysis sufficiency being near the vessel without any disorders in muscular layers of vascular wall.
EFFECT: higher efficiency of therapy.
2 dwg, 1 ex
FIELD: physiotherapy and health resort treatment.
SUBSTANCE: before treatment, condition of vegetative nervous system is examined and, when initial vegetative tonus is regarded as sympathicotonia and hypersympathicotonia, galvanization of collar region according to Shcherbak and common-use pearl bathes are recommended. When initial vegetative tonus is regarded as vagotonia, microwave therapy and common-use radon bathes are recommended.
EFFECT: increased treatment efficiency due to improved vegetative nervous system condition as well as general hemodynamic and biochemical and hormonal investigation characteristics.
5 cl, 7 tbl, 3 ex
SUBSTANCE: method involves applying combined trans-spinal micro-polarization and pulsed stimulation. The trans-spinal micro-polarization is carried out using constant current of 100-300 mcA by applying skin electrodes of 20-35 cm large area. The trans-spinal micro-polarization is carried out during 30-40 min. Anode is placed lateral with respect to spinal process of the seventh vertebra C7 and cathode is placed contralaterally with respect to the anode in lumbosacral zone at the level of spinal processes of L5-S1. Magnetic pulsed stimulation is carried out with short pulses having two in every emitted package. Magnetic induction amplitude of the first pulse is equal to 1400 mTesla units and of the second one is less by 55%. The pulses are sent along the right and left side of the vertebral column in turn giving 3-4 packages per each spine segment. Stimulation is started beginning from cervical segment. The total treatment course is 6-7 procedures long with pauses being not longer than 2 days.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: method involves treating immunocompetent organ regions with low frequency electric current for instance in animal groups like rats during 2 weeks. Drug-induced immunodeficiency is modeled in the animals 2 days later, after the treatment course is over, by intraperitoneally introducing 2% cyclophosphan solution once per 3 days (the total preparation dose is equal to 42 mg). Spleen and thymus mass, antibody-forming cells quantity in spleen and phagocytic activity of leukocytes are determined. Prophylactic action of factor of physical nature is evaluated by calculating prophylaxis index by dividing product of spleen mass, antibody-forming cells and phagocytic activity of leukocytes per thymus mass. The result is to be divided by 103. The prophylaxis index value exceeding 8.0, prophylaxis effectiveness is considered to be available.
EFFECT: high accuracy of estimates.
FIELD: medicine, neurology, physiotherapy.
SUBSTANCE: contact action by electric current on the region of the forehead and mastoid processes and contact action by magnetic field along the vertebral column are performed simultaneously. The action on the region of the forehead and mastoid processes is effected by direct current, 1 to 7 mA strong, modulated by low-frequency square pulses. A frequency within 0.5 to 550 Hz causing a change of the electrodermal resistance in the biologically active points is assigned as operating frequency. Action along the vertebras is effected by a pulse field with amplitude of magnetic induction up to 1 T and pulse frequency up to 100 Hz. The dominant frequency by the results of the electroencephalography is assigned as operating frequency, and the time of action is set to be equal to 35+-5 min. The device has an electrostimulator unit, whose output is made for connection to the electrodes in the patient's circuit, and a magnetic field forming unit with a solenoid, with a magnetic field forming unit with a solenoid, with power units each. The electrostimulator unit has a transducer of a series-connected master oscillator, transformer-coupled amplifier and a rectifier. The rectifier output is connected to the input of the first gate and made as the output of the electrostimulator unit. The device has a pulse shaper, whose output is connected to the input of the first gate, an output current level controller made for starting from the master oscillator, and whose output via the second gate and a ripple filter is connected to the transformer-coupled amplifier and the adder. The adder output is connected to the output of the first gate and the current meter. The magnetic field forming unit has a capacitor connected to the solenoid winding and via the switching unit - to the power unit. The switching unit is connected to the output of the control unit. The input of the pulse shaper of the electrostimulator unit and the input of the control unit of the magnetic field forming unit are made for connection to a personal computer via galvanic isolators.
EFFECT: reduced degree of disintegration in the structures of the limbic-reticular complex producing an optimizing action on the neurodynamics.
3 cl, 5 ex, 2 dwg
FIELD: medicine, reflexotherapy.
SUBSTANCE: one should match biologically active points and with subsequent impact upon them. One should choose biologically active point that corresponds to an organ with pathological cell proliferation. Then on should measure the potential of chosen biologically active point against a reference point. Then it is necessary to switch on the external source of direct electric field to chosen points. The poles of this source should be opposite by sign to those of points, and its absolute value is equal to the difference of absolute values of measured potential and a potential corresponding to healthy organ in chosen point. The impact should be performed up to the value of membranous potential of cancer cell being equal to the value of membranous potential of corresponding healthy organ. The innovation suggested simplifies therapeutic technique.
EFFECT: higher efficiency of therapy.
FIELD: medicine, gynecology.
SUBSTANCE: one should carry out galvanization during 15 min due to applying electrodes along abdominal-sacral technique. Just before galvanization one should introduce 15 ml 2%-chitosan ascorbate gel containing metronidasol at the dosage of 2 mg/ml gel, intravaginally at 36-38° C. Procedures should be carried out once daily, therapy course lasts for about 7-8 d. The innovation suggested provides total curative effect of antibacterial remedies and galvanization at decreased dosage of metronidasol and, thus, enables to obtain stable remission of salpingo-oophoritis.
EFFECT: higher efficiency of therapy.
1 ex, 1 tbl
FIELD: medicine, gynecology, immunology.
SUBSTANCE: for microenemas carried out just before galvanization according to abdominal-sacral technique one should apply 1%-chitosan ascorbate gel at the quantity of 20 ml, at temperature of 36-38° C, once daily, about 8-9 procedures/course. The present innovation enables to decrease inflammatory conglomerate and prevent massive adhesion-formation due to creating rectal enterosorbent depot that enables to enhance the sorption of toxic products through rectal wall out of inflammation focus.
EFFECT: higher efficiency of therapy.
1 ex, 3 tbl