Method for differential diagnostics of infiltrative pulmonary tuberculosis and chronic bacterial pneumonia

FIELD: medicine, phthisiology.

SUBSTANCE: one should lymphotropically introduce the mixture of 5.0 ml 0.25%-novocaine solution and 2.0 ml 1%-dioxidine solution or the mixture of 5.0 ml 0.25%-novocaine solution and 0.5 g cefazoline subcutaneously into jugular cavity and deeply behind xiphoid process, successively 1 point once daily, 5-7 injections/course. After injection the site of injection should be treated either with heparin ointment or ultrasound (1-3 MHz, PPM 0.2 W/sq. cm, for 2 min, through Vaseline oil) followed by evaluating roentgenological dynamics of the process 10-14 d later.

EFFECT: higher efficiency of differential diagnostics.

3 ex

 

The invention relates to medicine, namely to Phthisiology and pulmonology, and can be used for differential diagnosis between inflammatory processes of specific and nonspecific etiology.

There is a method of differential diagnosis of infiltrative tuberculosis and protracted pneumonia with treatment of the test nonspecific antibacterial drugs within 10-14 days, followed by evaluation of x-ray dynamics infiltrative changes in the lungs. When the resorption process is considered to be nonspecific, while maintaining infiltrate without speakers or growth changes with high probability, the process is specific, that is, TB (Milkamanovich VK Diagnosis and treatment of respiratory diseases. “Polifakt-Alpha”, Minsk. - 1997. - S).

The disadvantages of the method:

1. Requires the use of large doses of nonspecific antibiotics for a long period of time (2-4 weeks), the introduction of drugs several times a day.

2. The high frequency of allergic and toxic complications from antibiotic therapy.

3. The low specificity of the test, so it is possible the lack of positive dynamics of the process with pneumonia.

4. A significant portion of antibacterial drugs entered the traditional intramuscular, p is ruralni ways, inactivated in the liver, not reaching the lesion in the lung.

The invention is aimed at solving problems: improving the accuracy of differential diagnosis, faster diagnosis, saving medicines.

These objectives are achieved by creating a lasting and high concentrations of nonspecific antibacterial drugs in the lung tissue and the lymphatic system of the lung when reducing the input dose, improve lymphatic drainage of the lungs, providing anti-inflammatory effect, which leads to more rapid and complete resorption of nonspecific inflammatory infiltrate.

This happens due to the regional lymphotropic the introduction of antimicrobial drugs, which drugs enter in the affected lung, bypassing the liver, where usually their inactivation. Put the drug in large numbers comes in hilar lymph nodes and lungs through the lymphatic vessels, non-vascular paths importantpart and through the right lymphatic duct and the thoracic duct in the pulmonary circulation. When lymphotropic the introduction of a high concentration of antibiotics and antiseptics not only in the lung tissue, but in the top region of the lungs lymph nodes. This allows for the most effectively influence will excite the La pneumonia, even if the treatment was ineffective, improve lymphatic drainage, i.e. to strengthen sanogenic the effect of therapy, to improve the resorption of inflammatory exudate, reduce fibroblastoma.

The method is as follows: the patient is administered a mixture of 5.0 ml of 0.25% solution of novocaine and 2.0 ml of 1% solution dioksidina or a mixture of 5.0 ml of 0.25% solution of novocaine and 0.5 g of Cefazolin subcutaneously into the jugular depression, deep behind the xiphoid process, consistently 1 point 1 once a day, 5-7 injections on the course. After the injection point injection process heparin ointment or ultrasound (1-3 MHz, PPM 0.2 W/cm2, 2 min, through vaseline oil), followed by evaluation of x-ray process dynamics 10-14 days. In the presence of resorption infiltrative changes, the process is considered non-specific.

Examples of specific applications.

Example No. 1.

Patient G., 53 years old, unemployed. For many years endured nonspecific pneumonia, which was formed bronchiectasis in the lower lobe of the left lung. The patient is abusing alcohol, the unconscious refers to their health. Ill sharply with increasing temperature up to 39°, cough with difficult detachable purulent sputum. Radiographically detected increase infiltration in the lower lobe of the left lung. Get the course of ampicillin and gentamicin, aerosol antiseptic place of residence within one month without a positive effect. Were increasing infiltrative process. The purpose of differential diagnosis with infiltrative tuberculosis enrolled in the TB hospital. After a comprehensive evaluation, which did not allow to unambiguously establish the diagnosis, course was held lymphotropic the introduction of 1% dioksidina 2,0 mixed with 5.0 ml of 0.25% novocaine consistently in the jugular point and the xiphoid process, daily 1 time per day, number 7, with the influence of ultrasound on the point of introduction after each injection. Conducted x-ray examination after 12 days, found a partial resolution of the infiltrate. The process is regarded as community-acquired bacterial pneumonia, severe, protracted course on the background of multiple bronchiectasis in the lower lobe of the left lung in acute phase.

Example No. 2.

Patient R., aged 45, works as a watchman. Ill acutely after exposure to cold, with symptoms of severe intoxication, productive cough, self-medicate, sought medical help after 10 days of illness. Radiographically detected infiltrative changes in the apex of the left lung and the lower lobe of the right lung to collapse without liquid level. Brother of the patient is registered by a TB specialist with active tuberculosis who m the lungs. Received treatment with aniccam 10 days, then carzola 7 days. Radiographically expressed by speakers are not obtained, but clinically achieved normalization of temperature, a decrease cough. Sent to the TB with suspected tuberculosis. Continued antibacterially therapy with Cefazolin, the drug was administered once daily at a dose of 0.5 g lymphotropic 5.0 ml of 0.25% novocaine in the jugular point and point xiphoid process, from the processing point of introduction of heparin ointment after injection, No. 7. When the x-ray control after 10 days of partial resorption of infiltration, reduction of land degradation. Inflammatory changes in the lungs regarded as community-acquired destructive pneumonia With1-2the left and9the right lung, severe, protracted course. In subsequent antibiotic therapy continued.

Example No. 3.

Patient K., 38 years old, unemployed. Ill sharply with increasing temperature up to 38.5°With cough. Radiographically defined infiltrative shadow in 6 of the right lung without dissolution and foci around. Was treated by a physician nonspecific antibacterial agents with some improvement of health, but without the expressed radiological improvement. A history of stay in prison. The purpose of differential diagnosis was applied daily lymphotropic call for the giving of 2.0 ml of 1% dioksidina with 5.0 ml of 0.25% novocaine in point jugular and xiphoid process No. 5, with the x-ray control after 14 days. The dynamics of the process are not obtained. Started a specific course of TB treatment. After 3 weeks received the growth of M. tuberculosis from sputum. Diagnosed with infiltrative tuberculosis 6 of the right lung, the office -/+. Thus, in the complex diagnostic procedures, use of a trial lymphotropic nonspecific antibacterial therapy allows you to speed up the diagnostic process, to obtain an economic effect.

The positive effect of the proposed method is:

- creation of high therapeutic concentrations of antibiotics or antiseptics in the lung tissue and lymph nodes while reducing their dose and frequency of administration;

to accelerate resorption infiltrative changes nonspecific nature;

additional anti-inflammatory effect by improving lymphatic drainage;

- reduce the frequency and severity of toxic and allergic reactions to antibiotics.

The method of differential diagnosis of infiltrative tuberculosis of the lungs and protracted bacterial pneumonia with medical therapy followed by evaluation of x-ray process dynamics 10-14 days, characterized in that as the medical treatment of the test use a mixture of 5.0 ml of 0.25%solution of the novocaine and 2.0 ml of 1%solution dioksidina or 0.5 g of Cefazolin, you enter lymphotropic subcutaneously into the jugular depression, deep behind the xiphoid process, consistently 1 injection 1 time per day with the subsequent processing of the point of injection of heparin ointment or ultrasound treatment 5-7 injection.



 

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