Method for treating the cases of lung carcinoma
SUBSTANCE: method involves applying surgical intervention and antitumor therapy. After having removed a part or the whole lung, mediastinum is opened by cutting out horseshoe-shaped or rectangular flap of mediastinal pleura and carrying out lymphodissection. Then, hemostatic sponge is placed in mediastinum. The sponge is impregnated with antitumor chemotherapeutical preparations in intraoperative mode. Pleura is sutured above the sponge. Another hemostatic sponge impregnated with cytostatic preparations in intraoperative mode is attached to visceral pleura of interlobular sulcus.
EFFECT: prolonged chemotherapeutical preparations delivery to malignant neoplasm foci or subclinical metastases.
The invention relates to medicine, in particular to cancer, and can be used in the surgical treatment of resectable, including locally common forms of lung cancer.
Known “Method of preoperative treatment of cervical cancer” (see Ed. mon. No. 577036, publ. Bull. No. 39 from 04.11.77, Ed.: Achance, Agilista, Useduring, Vampirer), including a total of chemotherapy and local impact, characterized in that the injected endolymphatic mix methotrexate and thiotepa with simultaneous local impact olivomycini ointment. While the tampon from 0.2% olivomycini ointment, which should be closely adjoin cancer of the surface of the cervix within 6-8 hours, administered daily for 20 days. Clinical positive effect in enhancing the effectiveness of cancer treatment.
However, the known method is limited in application. It can be used in gynecology for the treatment of cancer of the cervix and uterine body, oncopathology. Using the method of local effects on cancer requires further development and improvements.
Known “Way to stop the capillary and parenchymal bleeding in surgical interventions (see Medmaravis. Medicinal product. - M - 1984. - page 84), we have chosen as a prototype, which is put the m application to bleeding surfaces as a hemostatic collagen sponge or tamponade her sinuses of Dura mater and other wound sites. A hemostatic sponge has not only hemostatic, and antiseptic (boric acid - 0.0125 g and furatsilin 0.0075 g per 1 g of dry sponge) effect, stimulates the regeneration of tissues. Left in the wound or cavity, it is completely absorbed. Side it effects were not identified.
The aim of the invention is the creation in the mediastinum and (or) the pleural cavity depot anticancer drugs for prolonged local effect on not deleted during the operation foci of malignant neoplasms or subclinical metastases of cancer.
This objective is achieved in that, after removal of part or all of the lung produce the dissection of the mediastinum, cut out horseshoe-shaped or rectangular flap mediastinal pleura, producing dissection, and then placed in the mediastinum hemostatic collagen sponge, intraoperative impregnated with a solution of anticancer chemotherapy, the pleura over the sponge is taken; with partial resection of the lung other hemostatic collagen sponge, intraoperative soaked in a solution of cytostatics, is fixed to the visceral pleura midlevel furrow, gradual resorption of the hemostatic collagen sponge provides a prolonged receipt of chemotherapy for malignant lesions novobrisov the Oia or subclinical metastases.
The invention is a Method of treatment of lung cancer” is new, because it is not known from the level of medicine in the field of Oncology in surgical and chemotherapeutic treatment of operable, including locally common forms of lung cancer.
Comparative analysis of the proposed method with known, used to treat lung cancer patients, showed that the proposed method has significant differences and novelty, as it provides for the creation during the operation of the depot anticancer drugs by putting in the mediastinum and (or) the pleural cavity hemostatic collagen sponge, intraoperative propitannoe solutions of these drugs. It should be noted that collagen hemostatic sponge with antiseptic properties, does not require an additional antiseptic techniques. There is a method local impact tampons with olivomycini ointment, providing anti-tumor effect is unacceptable, because it is technically impossible to have daily access to the lung and the mediastinum to the introduction there tampons with olivomycini ointment. Topical medicines are used in thoracic surgery exclusively for pleural empyema and mediastinitis for tamponade of purulent cavities when they are open. Leaving during the Opera the AI in the pleural cavity or mediastinum tampon with plain water-soluble anticancer remedies for a few days also unacceptable due to technical difficulties during its extraction and the threat of purulent-septic complications due to the presence in the mediastinum or pleural cavity foreign body (gauze swabs).
The proposed method is industrially applicable, as it can be repeated many times in the treatment of lung cancer patients in specialized medical treatment and preventive health care.
“A method for the treatment of lung cancer” is as follows.
Patient with histologically confirmed lung cancer under endotracheal anesthesia perform a thoracotomy, a revision of the lung and mediastinum, and then produce a radical stage surgery (lobectomy, bilobectomy, however, PDT them extended or combined options). Mediastinal pleura is opened by cutting out the horseshoe-shaped or rectangular flap, facing the base of the medial. According to the testimony produced mediastinal dissection. After controlling hemostasis in the mediastinum put 1-2 hemostatic collagen sponge, intraoperative impregnated with solutions of anticancer chemotherapy (cyclophosphamide, 5-fluorouracil or other). The pleura mediastinal sutured. Partial resection of the lung other hemostatic collagen sponge, intraoperative infiltrated chemotherapy, optionally fixed to the visceral pleura in midlevel is oronde. Next, the operation ends normally.
Gradually dissolving, hemostatic collagen sponge provides a slow release of her chemotherapy drugs, which affect the remaining or hidden foci of malignant neoplasms or metastases.
The method was tested in the treatment of lung cancer patients. Examples of specific applications can serve as a statement of history.
App.1. Sick And s N.A. born in 1937, the case history No. 447/W, was admitted to the thoracic Department of RNII with complaints of cough with mucopurulent sputum and blood streaks, shortness of breath during exercise, the body temperature rise to febrile digits, the loss in weight of 5-6 kg
Before enrolling in a month and a half with no effect was treated at the place of residence about the proposed left-sided pneumonia.
The survey of radiographically detected Central cancer in the lower lobe of the left lung with its atelectasis. The root of the lung is not differentiated due to enlarged lymph nodes. On the tomogram is “stump” proximal bronchus. If fibrobronchoscopy diagnosed with cancer of the proximal bronchus confirmed. Cytologically verified squamous cell carcinoma. Data for the presence of distant metastases, the patient is not identified.
19.11.02 under endotracheal anesthesia produced side by thoracotomy the I in the 5th intercostal space on the left. If the audit reveals a dense, rough tumor, enveloping the proximal bronchus. The lower portion atelectasia, infiltrated through the inflammatory process. Infiltration extends to the upper portion, and pulmonary ligament. At the root of the lung and mediastinal enlarged lymph nodes. In the pleural cavity to 300 ml of effusion.
The patient made pulmonectomy to the left, then from the mediastinal pleura was cut rectangular flap. Through defect pleura produced lymphadenectomy performed hemostasis. In the mediastinum placed two standard hemostatic collagen sponge, intraoperative impregnated with solutions of anticancer drugs (2000 mg of cyclophosphamide, 1000 mg of 5-fluorouracil) and then the mediastinum sutured by filing earlier cut of the flap to the mediastinal pleura. Drainage in the 8th intercostal space. The wound is sutured in layers tightly.
The postoperative period was uneventful. Dyspeptic disorders and other manifestations characteristic of chemotherapy, has not arisen. The drainage was removed on the second day, the sutures were removed on the seventh.
Histological analysis No. 670253-256 revealed moderately differentiated squamous cell carcinoma with keratinization, in the lymph node hyperplasia, lymphoid tissue, metastasis no.
The patient was discharged from hospital to meet the sustained fashion the state under the supervision of ryonasaga. Viewed through four months after surgery. The condition is satisfactory. Data for disease recurrence and distant metastases not identified. Observation continued.
PR. Patient C-h F born in 1937, the case history No. 1957/0, entered the thoracic Department of RNII in connection with identified during preventive examination of peripheral cancer of the upper lobe of the right lung, stage I In (T2N0M0).
The patient is an invalid of the second group about obliterating atherosclerosis of vessels of lower extremities, and therefore five years ago he was amputation of the lower third of the right thigh.
At admission the patient complains of cough with scanty mucous sputum, shortness of breath during physical activity.
When x-ray examination of the patient in the upper lobe of the right lung revealed peripheral education up to 4.5 cm in diameter with rough contours and cavity decay. Radiographically cancer. During bronchoscopy, the tumor is not detected, detected bilateral endobronchitis. Data for the presence of distant metastases not detected.
24.12.02 - under endotracheal anesthesia produced lateral thoracotomy right on the 5th Mirabello. After mobilization of lung adhesions produced audit, which revealed a tumor in the upper lobe. At the root of the lung multiple small lymph usila made upper lobectomy, then arc (u) access opened the mediastinum. Enlarged lymph nodes were found. In the mediastinum placed hemostatic collagen sponge, intraoperative infiltrated 20 mg of cisplatin. Mediastinal pleura sutured. Other hemostatic collagen sponge impregnated with a solution of 5-fluorouracil (1000 mg), fixed in magdalenas the groove between the middle and lower lobes. Operation complete drainage of the pleural cavity and layer-by-layer wound closure. Histogenesis No. 674631-636 - squamous cell carcinoma moderately differentiated carcinoma, marked chronic inflammation. The postoperative period is smooth. Complications associated with chemotherapy, was not. Was discharged in good condition under the supervision of ryonasaga.
At the control examination after three months, no complaints. Data for recurrence or distant metastases were not found. Observation continued.
Technical and economic efficiency of the proposed “method of treatment of lung cancer” is:
- creating a depot of anticancer drugs in the area of surgical intervention for routes of regional lymph and blood flow, the prolonged effects of drugs on the remaining foci of tumor or hidden metastases;
provide an additional antiseptic is stimulating the regeneration of action due to the properties of the hemostatic collagen sponge;
improving quality of care and life of patients.
A method of treating lung cancer, including surgery and anticancer chemotherapy, characterized in that after removal of part or all of the lung produce the dissection of the mediastinum by cutting out the horseshoe-shaped or rectangular flap mediastinal pleura, lymph node dissection, and then placed in the mediastinum hemostatic collagen sponge, intraoperative impregnated with solutions of anticancer chemotherapy, the pleura over the sponge is sutured, with partial resection of the lung other hemostatic collagen sponge, intraoperative also impregnated with drugs, is fixed to the visceral pleura midlevel furrow; gradual resorption of the hemostatic collagen sponge provides a prolonged intake of drugs to the remaining foci of malignant neoplasms or subclinical metastases.
FIELD: medicine, hematology, pharmacy.
SUBSTANCE: invention relates to the composition of factor VIII composed without addition of albumin and comprising the following excipients of composition in addition to factor VIII: from 4% to 10% of filling agent taken among group consisting of mannitol, glycine and alanine; from 1% to 4% of stabilizing agent taken among group consisting of sucrose, trehalose, raffinose, arginine; from 1 mM to 5 mM of calcium salt, from 100 mM to 300 mM of NaCl, and buffer agent for pH value maintenance about between 6 and 8. Alternatively, the composition can comprise from 2% to 6% of hydroxyethylstarch; from 1% to 4% of stabilizing agent taken among group consisting of sucrose, trehalose, raffinose, arginine; from 1 mM to 5 mM of calcium salt, from 100 mM to 300 mM of NaCl, and buffer agent for pH value maintenance between 6 and 8. In additional variant of realization of invention the composition can comprise: from 300 mM to 500 mM of NaCl, from 1% to 4% of stabilizing agent taken among group consisting of sucrose, trehalose, raffinose and arginine; from 1 mM to 5 mM of calcium salt, and buffer agent. The composition provides stability in the absence of albumin or other proteins.
EFFECT: valuable properties of compositions.
35 cl, 11 tbl, 7 ex