Combined medical-laser treatment of purulent diseases of fingers and hands
The invention relates to medicine, namely purulent surgery. A patient with purulent diseases of fingers or brush on the upper third of the forearm is superimposed venous tourniquet. Distal to it in the vein of the jet is injected 160 mg gentamicin sulfate. Immediately after that, irradiation with fingers and brushes low intense infrared laser radiation of a wavelength of 890 nm, power density of 0.9 W/cm2, a pulse frequency of 80 Hz. Irradiated for 5 minutes. The method allows to increase the supply of the antibiotic in the soft tissue from the bloodstream, improve local protective response of the soft tissues of the brush, enhance reparative regeneration of tissues in the impact zone. 1 PL.
This invention relates to medicine, namely to purulent surgery, and can be used in other areas of medicine, such as traumatology, dermatology.
Known methods of treatment of purulent diseases of fingers and brush the introduction of antibiotics intravenously retrograde under the harness. However, when introducing processes develop disorders of microcirculation, namely stasis and thrombosis in venules and capillaries that prevents the full vasavi brush. HP: Medicine, 1975).
Used for the treatment of inflammatory diseases of fingers and wrist laser therapy. Infrared low-intensity laser irradiation has a biostimulating effect, does not have a bacteriostatic or bactericidal effect on microorganisms (C. E. Illarionov. Fundamentals of laser therapy. M: Respect, 1992).
Closest to the claimed method of administration of the antibiotic in soft tissue using electrophoresis. However, the method has a negative side: 1) the electrodes must be placed in the immediate vicinity of purulent wounds, for which it is necessary to remove the bandage; 2) electric effect on the tissue is used only for carrying out the antibiotic in the tissues and does not have independent therapeutic effect; 3) during the treatment the patient has contact with electric current (Reference physiotherapy. Ed. Century, Yasnohorodska. M.: Medicine, 1992).
The purpose of the invention is to eliminate these shortcomings, namely the simplification of the way, enhancing therapeutic effect: the increase in the revenues of the antibiotic in the soft tissue from the bloodstream, increasing local protective response of the soft tissues of the brush, the strengthening of reparative regeneration of tissues in tie granulation and wound healing.
This objective is achieved in that in the method of treatment of purulent diseases of fingers and hands, including concomitant medication and laser treatment, the patient put the tourniquet on the forearm for 15-30 minutes, intravenous 160 mg gentamicin sulfate in Vienna, located distal to the tourniquet, irradiated brush and fingers without removing the bandage, laser radiation with a wavelength of 890 nm and a power density of 0.9 W/cm2with a pulse frequency of 80 Hz for 5 minutes.
Gentamicin sulfate has a broad spectrum of antimicrobial activity, inhibiting the growth of most gram-negative and gram-positive microorganisms. For microbial cell gentamicin sulfate acts bactericidal, inhibiting protein synthesis in the breeding cage. Kinetics of gentamicin intravenously is determined by the speed of infusion, with the rapid intravenous injection (within 5-15 minutes), the levels of drug in the blood is highest and created the best conditions for diffusion gentamicin sulfate in tissue. At high tissue concentrations of gentamicin sulfate inhibits the development of more than 80% of strains of Pseudomonas aeruginosa and 90% of strains of Escherichia coli, 70% of germs groups Klebsiella-Enterobacter and almost 100% of strains one hundred and the. Fomin. Rational antibiotic therapy. M.: Medicine, 1982).
Infrared laser therapy has many positive effects on the inflammatory process, which consists in the activation of cell metabolism and increasing their functional activity, stimulation of reparative processes in the activation of blood microcirculation and increasing trophic level security tissues, analgesic and immunostimuliruyushhim action, without affecting the bacterial agents (C. E. Illarionov. Fundamentals of laser therapy. M: Respect, 1992).
The combination of bactericidal action of gentamicin sulfate and biostimulating effect of infrared laser radiation leads to increased therapeutic effects on inflamed tissue of the fingers and hands. In addition, the combined use of medication and laser therapy is not only the folding of positive action methods, and strengthening the actions of each of the factors, there is a synergistic effect. Infrared laser therapy improves microcirculation, provides rapid and complete absorption of the antibiotic in the soft tissue from the bloodstream, which further increases the concentration of the drug.
Reaction g the thieves: 1) gentamicin sulfate; 2) gentamicin sulfate with L--lecithin, which simulates the lipid matrix of the membrane; 3) gentamicin sulfate with L--lecithin, albumin and saline solution of 0.9% sodium chloride that simulates the serum. A series of studies conducted in two modes: the first is the exposure of the environment with subsequent introduction of gentamicin sulfate and second, the introduction of antibiotics and subsequent irradiation. In the study as the main methods used refractometry and polarizing microscopy, as an additional technique involved spectrophotometry.
Refractometry is a method of research and analysis of substances, based on the measurement of their refractive index. The refractive index of a substance is the ratio of the speed of light in vacuum to its velocity in the substance. The refractive index is determined by the nature of the substance and depends on external conditions (temperature and pressure) and the wavelength of light at which the measurement is carried out. The value of the refractive index is closely connected with such fundamental characteristics as polarizability, that is, the ability of electronic shells of atoms, ions and molecules to deform in an external electromagnetic floor in order to solve such problems, as the definition of the type of chemical communication, detection and characterization of hydrogen bonds, the study of the structure of complex compounds and mutual influence of atoms in them, the calculation of interatomic distances, determining the concentration of two-component solutions, the characteristics of purity and others. The refractive index at a given temperature and wavelength is an important constant characterizing the chemical structure, which, together with the melting and boiling is one of the characteristics of matter. Measurement of refractive index was performed on the Abbe Refractometer type CRF-454 B (B. C. Joffe. Refractometric methods in chemistry. L.: Chemistry, 1983).
Polarizing microscopy allows to observe objects in polarized light and is used to study drugs, the optical properties are heterogeneous, i.e. the so-called anisotropic objects. Drop the investigated medium is placed between the objective and the cover glass. The sample is maintained in a thermostat at 37° C during the day for a more complete manifestation of the peculiarities of structure formation. To view the used optical polarizing microscope FLOORS R-211-mode polarized light (pikh phases and morphology of the crystalline phase (C. M. Lisienko, E. C. Zepecki, E. C. Kononenko, R. I. Mintz. In vitro liquid diagnosis of cholecystitis. Sverdlovsk (in Russian) uh-HUH, 1989).
Spectrophotometric studies were carried out on the instrument, the SF-26; as a reference absorption used distilled water in a quartz cuvette. The compensation method was estimated absorption coefficient of laser radiation is a solution of the drug ratio
Spectrophotometric study of aqueous solution of gentamicin sulfate in the wavelength range from 750 to 1050 nm does not detect a maximum absorption, indicating the absence of selective acquisitions in this area, the relevant range of used low-intensity laser radiation.
Made refraction study indicate a significant change in the refractive index. Exposure to the actual solution of gentamicin sulfate changes the refractive index only 0,0008 Rel. units In the model environment gentamicin sulfate with L--lecithin refractive index is changed to 0,0004 Rel.ed. In the modeling environment gentamicin sulfate with L--lecithin, albumin and physiological the future with the polarizability of the molecules. The more pronounced changes occur with the drug in irradiated or irradiated with infrared laser radiation environment.
When the polarization microscopy after 48 hours in drugs gentamicin sulfate formation structures is not observed. Drug gentamicin sulfate with modelnymi systems irradiated by an infrared laser, there is a small amount of structures. With the introduction of gentamicin in the already irradiated system the number of structures increases. Pre-irradiation environment, simulating membrane matrix, with subsequent introduction of gentamicin sulfate causes a significant (5-fold) increase in the size and number of structures of liquid crystalline phase compared to the irradiation of pre-prepared mixture. In the system modeling the serum, the number of structures of liquid-crystalline phases and the dynamics of their changes similar: birefringent (anisotropic) structures more and they are more pronounced in the preliminary irradiation environment.
Experimentally obtained conclusion about the advisability of introducing gentamicin sulfate in irradiated or irradiated environment was the basis for treatment as SPO is La 1999 after 8 days from the onset of the disease with a diagnosis of a Bone felon on 1 finger of the left hand. On the day of admission the patient had an operation: cut, necrectomy carbon dioxide laser, open drainage. February 10, started a course of combined medical-laser treatment. On the left forearm in the upper third of the imposed venous tourniquet distal to it in the vein of jet entered 160 mg gentamicin sulfate, immediately after irradiation produced 1 finger of the left hand of infrared laser radiation of a wavelength of 890 nm, a power of 0.9 W/cm2with a pulse frequency of 80 Hz, the harness is removed after 20 minutes. Such procedures were five: 10, 11, 12, 15 and 16 February. Swelling of the left hand disappeared on the second day, local tissue necrosis disappeared on the third day, then disappeared soreness when moving the brush, on the fifth day there was a good juicy granulation, on the ninth day - marginal epithelization. The wound is reduced lakoplastyrna bandage and on the fifteenth day the patient was discharged with longer healed wound.
To prove the effectiveness of the proposed method of treatment of purulent diseases of fingers and brush analyzed the history of the disease, divided into three groups: experimental (applied concomitant medication laser treatment), control 1 (applied intravenously retrograde introduction of antibiotic is itov in the blood as the most frequently used in practical medicine index; leukocyte index of intoxication Calf-Khalifa (LII) as an integrated indicator of intoxication and factors of local immunity - lysozyme as the protective properties of those tissues that are the first to come in contact with infectious agents; phagocytosis as one of the most powerful ways of protection, and circulating immune complexes as a universal stimulants neutrophilic phagocytosis.
The research results are summarized in the table.
The table shows that at the time of hospitalization named parameters in all groups is approximately the same (the difference is not statistically significant), indicating that the same severity patients. After treatment dynamics is more pronounced in the experimental group (difference statistically significant). Pay attention to the number of circulating immune complexes in the group who received only intravenous antibiotics, there was a sharp depression of local immunity after completion of treatment. This is probably due not only to previous inflammatory process of the brush, but with the immunosuppressive effect of the antibiotic.
In addition, the estimated rate of healing of the wound defect Nouneh diseases fingers and hand speed wound healing was 7,06±0,39% per day; when using only the laser - 5,46±0,11% when using only intravenous gentamicin sulfate - 3,99±0,94%.
The proposed method of treatment of purulent diseases of fingers and hands is based on the use in medicine of the previously known methods of treatment without changing their essence, when a positive effect is obtained thanks to a new application. The method allows to achieve earlier and more favorable healing of purulent wounds.
The way medical laser treatment of purulent diseases of fingers and hands, different combined simultaneous use of medication and laser treatment, namely, the patient put the harness on the upper third of the forearm in 15-30 minutes, retrograde intravenous 160 mg gentamicin sulfate in Vienna, located distal to the tourniquet, irradiated brush and fingers without removing the dressing, low-intensity infrared laser radiation with a wavelength of 890 nm and a power density of 0.9 W/cm2with a pulse frequency of 80 Hz for 5 minutes
FIELD: medicine, otolaryngology.
SUBSTANCE: the present innovation deals with introducing neomycin sulfate antibiotic in granules prepared by the following technique. Tablet of neomycin sulfate 1.0g should be put into a vial with 100 ml distilled water till tablet's decomposition. Then vial's content should be shaken and kept till suspension sedimentation. In a day one should take 1 ml of supernatant liquid to be put into another vial and diluted with distilled water at 1:100 ratio. This procedure should be repeated 4 times more, moreover, during the last procedure one should apply alcohol for dilution. Then one should transfer the drop of alcoholic solution into a vial with granules out of milk sugar to then shaken and kept open for 1 d till granules" drying up. The suggested preparation should be applied per 1 granule under the tongue, moreover, multiplicity and duration of the above-suggested intake should be matched individually by patient's sensitivity and obtaining the clinic effect. The method enables to improve the value of tonic threshold audiometry by about 30-50 dB, decrease perception threshold of vocal range frequencies and widen the range towards high frequencies.
EFFECT: higher efficiency of therapy.