Method for eliminating lacrimal canaliculus
SUBSTANCE: method involves probing and rinsing lacrimal canaliculus. Working nozzle of YAG laser is additionally introduced into lacrimal canaliculus to reach medial wall of the lacrimal sac. The working nozzle of laser is taken away from the medial lacrimal sac wall in the reverse direction by 2 mm. Laser radiation treatment is applied in constant wave mode (CW) with power of 2.5 W during 5 s in smoothly moving laser working end from the lacrimal canaliculus. The lacrimal canaliculus is washed with corticosteroids.
EFFECT: enhanced effectiveness of treatment.
The invention relates to medicine, namely to ophthalmology, and can be used to create the lacrimal fluid outflow when limited obliteration of lacrimal canaliculi.
Currently, the problem of surgical treatment of diseases of the lacrimal passages are still far from the final solution and requires further study and improvement.
A known method of surgical treatment of limited obliteration of lacrimal canaliculi (like m.l.krasnov, Vasev. The guide eye surgery. -Moscow: Medicine, 1988. -P.472). The method consists in the following. In the lacrimal canaliculus injected conical probe, which break adhesions, and spend it in the lacrimal SAC to the inner wall and leave there. After that make the skin incision with a length of 1.5-2.0 cm 3-5 mm above the inner eyelid adhesions at a distance of 3-4 mm from it to the side of the nose, below the cut is bent outwards. Usepreview the soft tissue at the side of the nose, find inner spike century, which is cut, if the lacrimal SAC is small. Then check the movement of the probe, whether it is in the lacrimal SAC, then through the lacrimal canaliculus spend shortened to 2/3 normal sewing needle with a tuft of horsehair. The wall of the lacrimal SAC puncture needle, hair bun output and connect their ends, sew up the wound. The wound edges smeared solution of brilliant green is my, for ever put antibacterial ointment and dressings. Bunch of hair, leave for 2-3 weeks. To prevent Sardinia lacrimal canaliculi a tuft of hair prodelyvat daily and the other side.
The disadvantage of the above method are the skin incision, holding horsehair with its subsequent prodelyvaniem.
The closest in technical essence is a remedy obliteration of lacrimal canaliculi by mechanical expansion of the lacrimal canaliculi (Grammatikovskiy, Try. A practical guide to treatment of diseases of the lacrimal organs. -Minsk: Belarusian science”, 2000. -S). The method consists in the following. After epibulbar anesthesia 0,25-0,5% solution dikaina and infiltration with 2% solution of novocaine (1.0 to 1.5 ml) in the area of tubule last extend initially conical, and then the cylindrical probes to # 3. Control lavage ensure patency of the lacrimal passages. In a few days in the conjunctival SAC buried disinfectant drops.
This method of treatment provides a high (60-70%) therapeutic effect, however, this method has limitations and drawbacks: when you break the adhesions probe bleeding occurs, increasing the duration of operation and in the postoperative period is the development of a secondary infection, re-poured the radio lacrimal canaliculi.
The technical result of the invention is to significantly improve functional and cosmetic effect, reducing the morbidity of the operation.
This technical result is achieved by the method of elimination obliteration of lacrimal canaliculi, which consists in probing of lacrimal canaliculi first cone, then cylindrical probes to No. 3, the irrigation of the lacrimal canaliculi, the impact YAG laser radiation on the walls of the lacrimal canaliculi in the continuous wave (CW) output power of 2.5 watts for 5 seconds and repeated washing of the lacrimal canaliculi corticosteroid.
The specified mode is set experimentally. Work the tip of the laser is in the diameter of 0.56 mm, after sensing passes freely inside the lacrimal canaliculi, and coagulating (including antibacterial and hemostatic) the laser be on the areas of direct contact with the wall of the lacrimal canaliculi. Washing corticosteroids reduced the inflammatory process that occurs when exposed to a laser. At lower power or duration of radiation is not provided functional outcome in the long term (>1 year) observations (obliteration occurs in 60% of cases - as in the absence of laser irradiation). With increasing power or deletelines and radiation begin to show signs of tissue necrosis, in the long term obliteration occurs in 70% of cases.
The proposed method reduces the likelihood of bleeding, surgery duration, observed high accuracy and melodramatically operations. In the postoperative period is not observed complication secondary infection, long-term (over 1 year) is high (85%) functional effect.
The method is as follows.
After epibulbar anesthesia with 0.25%and 0.5% solution dikaina and infiltration with 2% solution of novocaine (1.0 to 1.5 ml) in the area of tubule last extend the first cone, and then the cylindrical probes to # 3. Control lavage ensure patency of the lacrimal canaliculi. Then in the lacrimal canaliculus enter the working tip of a YAG laser to the medial wall of the lacrimal SAC. After discharge of the working tip YAG laser from the medial wall of the lacrimal SAC in the opposite direction by 2 mm include laser installation and energy in continuous wave (CW) output power of 2.5 watts for 5 seconds smoothly (without jerking) deduce the working tip of the laser from the lacrimal canaliculi. Lacrimal canaliculus washed with corticosteroids when the operation completes and the next 3 days. Also over the next 7 days after surgery in the conjunctival SAC buried disinfectant drops.
Example 1. B is supplemented flax B. 37 years old, he enrolled in the eye Department with complaints of moderate tearing of the right eye, caused by obliteration of the lower lacrimal canaliculus. Objective examination of the patient notice: the stagnation of the tear stream, lachrymation of the right eye, the patient is forced to wipe the tears away every 25-30 minutes. The lacrimal punctum and the position of the eyelids of the right eye almost without pathological changes. When washing lacrimal passages installed the lack of permeability through the lower lacrimal point while maintaining a good road through the upper lacrimal point. On radiographs lacrimal passages with contrast agent installed obliteration of the lower lacrimal canaliculus in the medial part. When rinoskopii disorders of the nasal mucosa is not revealed: the nasal passages wide, pathological secretions in the nose no, breathe freely.
In connection with the identified obliteration of the lower lacrimal canaliculus is performed by the proposed method.
After epibulbar anesthesia 0,25-0,5% solution dikaina and infiltration with 2% solution of novocaine (1.0 to 1.5 ml) in the area of tubule last expanded first cone, and then the cylindrical probes to # 3. Control washing 1 ml of 0.1% hydrocortisone was convinced of the patency of the lacrimal canaliculi. Then tear the canadian entered the work Nakonechny the YAG laser to the medial wall of the lacrimal SAC. After discharge of the working tip YAG laser from the medial wall of the lacrimal SAC in the opposite direction by 2 mm included laser installation and energy in continuous wave (CW) output power of 2.5 watts for 5 seconds smoothly (without jerking) drew the working tip of the laser from the lacrimal canaliculi. Lacrimal canaliculus were washed in 1 ml of 0.1% solution of hydrocortisone in the conjunctival SAC buried 0.25% solution of chloramphenicol. After surgery in the next 3 days lacrimal canaliculus were washed in 1 ml of 0.1% solution of hydrocortisone and within 7 days in the conjunctival SAC of the right eye was buried 0.25% solution of chloramphenicol.
Operating and postoperative complications were not observed. The tears stopped. Patency of lacrimal passages recovered. Surveillance for 2 years showed the stability of the results.
Clinical observations were captured in 14 patients. Preoperative examination included: history, biomicroscopy, examination provisions of the lacrimal points and patency of lacrimal passages, endoscopic examination of the nasal cavity.
Physical examination before surgery in all patients the position of the correct age, the lacrimal punctum correct form. When pressed on the internal ligament eyes remained stagnant tear stream. When scanning active terrain with the help of the colored samples (tubular and nasal) revealed reduced patency of lacrimal passages in the obliteration of one of the tear tubules and absence of permeability with obliteration of both lacrimal tubules. On radiographs lacrimal passages with contrast substance was confirmed obliteration of lacrimal tubules. When endoscopic examination of the nasal cavity revealed that the anatomical changes that prevent operation no.
In the postoperative period was monitored condition kazootoys apparatus in different periods of time (daily for the first week after surgery, then after 1, 3, 9, 15, and 20 months). The results showed that kazootoys road passable in 12 (85,7%) patients.
Thus, the proposed method provides high functional recovery results of lachrymal, reduces the likelihood of bleeding, duration of operation, eliminates secondary infection, observed high accuracy and melodramatically operations.
Solution obliteration of lacrimal canaliculi, which consists in probing and irrigation of the lacrimal canaliculi, characterized in that it further in the lacrimal canaliculus enter the working tip of a YAG laser to the medial wall of the lacrimal SAC, assign work the tip of the laser from the medial wall of the lacrimal SAC in the opposite direction by 2 mm, the effect of laser radiation with a continuous wave (CW) power 2.5 W for 5 s, smoothly bringing the working tip of the laser from the lacrimal Kahn is Liza, lacrimal canaliculus washed with corticosteroids.
FIELD: medicine, otorhinolaryngology.
SUBSTANCE: one should treat deformation in laryngeal and tracheal lumen due to excessive growth of granulation tissue in the sites of their lesions. One should introduce hormonal preparations, moreover, one should apply Diprosan as a hormonal preparation injected once intramucosally at 0.1 ml/sq. cm of granulation tissue, but not more than 0.3 ml.
EFFECT: higher efficiency of therapy.
3 ex, 1 tbl
SUBSTANCE: method involves applying napkin impregnated with medicament to an injured articulation area. The medicament contains hydrocortisone acetate in the amount of 0.4mg/cm2, dimexide - 1.4 mg/cm2 and sodium alginate - 4.1 mg/cm2. The napkins are applied to internal and external side of the articulation for 6 days, changing them in three days.
EFFECT: accelerated treatment course.
FIELD: medicine, neurology.
SUBSTANCE: method involves intravenous administration of autolymphocytes treated with an immunomodulating agent by extracorporal method using cycloferon (250 mg) as an immunomodulating agent. Simultaneously, the following medicinal mixture comprising lidocaine, 100 mg; lidazum, 32 U; dexamethasone, 4 mg; leukinferon, 10 000 U; 40% glucose solution, 4 ml is administrated into interspinal ligaments of spinal column at levels corresponding to thoracal and lumbar enlargements of the spinal cord. The procedure is repeated three times with interval for 48-72 h. Method provides enhancing the effectiveness of lymphostimulation and immunomodulation in cerebrospinal sclerosis. Invention can be used for lymphostimulation and immunomodulation in cerebrospinal sclerosis.
EFFECT: improved method for treatment.
1 tbl, 1 ex
FIELD: medicine, oncohematology.
SUBSTANCE: the present innovation deals with treating elderly patients with chronic lympholeukosis accompanied with cardiovascular failure. The method deals with applying chemopreparations and cytoprotector. Moreover, 1 wk before the onset of chemotherapeutic therapy one should prescribe preductal at the dosage of 105 mg daily. At this background one should sample blood out of elbow vein at the volume of 200 ml into a vial with glugicir to centrifuge it, isolate plasma, divide into two portions, add into the 1st vial - cyclophosphan 600-800 mg/sq. m, vincristin 1.4 mg/sq. m, into the 2nd vial - adriamycin 50 mg/sq. m to be incubated for 30 min at 37 C and intravenously injected by drops for patients. Simultaneously, the intake of prednisolone should be prescribed at the dosage of 60 mg/sq. m since the 1st d and during the next 5 d and preductal at the dosage of 105 mg daily during a week, and then 2 wk more at the dosage of 60 mg daily. All the procedures should be repeated in above-mentioned sequence 4-6 times. The method enables to decrease toxic manifestations of chemotherapy while applying adequate dosages of cytostatics, anthracycline antibiotics, among them, at no great manifestations of their toxicity due to preductal's cardioprotective action.
EFFECT: higher efficiency of therapy.
1 ex, 5 tbl
FIELD: medicine, oncology.
SUBSTANCE: invention relates to a method for treatment of chronic lympholeukosis. Method involves intravenous drop and jet administration of antitumor chemopreparations and carrying out the autochemotherapy. At the 1-st and 8-th day of treatment cyclophosphan in the dose 750 mg/m2, vincristine in the dose 1.4 mg/m2 and doxorubicin in the dose 30 mg/m2 incubated with 200 ml of autoblood are administrated to patients. From the 1-st to 14-th day of treatment prednisolone is used every day in the therapeutic dose. The treatment course is repeated in 30-35 days depending on blood indices and patient state. The total treatment of courses is 4-5. Method provides reducing cardiotoxicity of doxorubicin and cumulative toxicity of chemopreparations that allows carrying out administration of antitumor chemopreparations in the full volume to patients of elderly age groups.
EFFECT: improved method for treatment.
SUBSTANCE: method involves cutting and separating conjunctiva and Tenon's capsule from limb allover its circumference. Specifying detachment area projection to sclera. Silicon ribbon is sutured and antibiotic is introduced. Next to it, limb-type self-sealing paracentesis is made with intraocular fluid being discharged through it under tonometry control. Inraocular pressure reaching 25 mm of mercury column, Tenon's capsule and conjunctiva is sutured.
EFFECT: enhanced effectiveness of treatment.
FIELD: medical engineering.
SUBSTANCE: device has handle having end rod and arch-shaped operation part mounted on rod at an angle to longitudinal handle axis. The rod is bent under blunt angle with area length distal from the handle being not less than 1/3 times arch-shaped operation part chord as long. The operation part is deformable plate curved in plane which bend is equal to tarsal plate curvature belonging to rod bending plane. The operation part is cutting edges on narrow surfaces and on the end face opposite to the rod.
EFFECT: improved engagement conditions of instrument operation part with tissues under surgical treatment and other instruments.
3 cl, 3 dwg
FIELD: medicine, ophthalmology.
SUBSTANCE: epithelial insulae should be affected with argon laser through corneal fragment at energy power being 0.2-0.3 mJ, spot's diameter ranged 100-500 mc, exposure being 0.2-0.3 sec, the quantity of applications ranged 10-15/seance. Therapeutic course should consist of 3-4 seances. The present innovation enables to remove epithelium from under corneal fragment due to applying noninvasive technique and avoid possible complications, such as the lesion of corneal fragment in case of repeated increase, epithelial growth and the development of infectious complications.
EFFECT: higher efficiency of therapy.
SUBSTANCE: method involves forming tunnel between sclera and Tenon's capsule towards the posterior eyeball pole in projection above the macular region in which flexible magnetic polymer implant is extrasclerally arranged. The implant is manufactured as 0.15-0.55 mm thick plate and is magnetized in perpendicular to plane surface with magnetic field intensity equal to 0.5-1.5 mTesla units. Magnetization pole S is built on one implant surface and N pole is built on the other surface. The magnetic implant is set with its S magnetization pole turned to the macular idiopathic rupture, the magnetic implant being not removable.
EFFECT: improved treatment efficiency; covered defect in macular region; stimulated microcirculation in retina and vascular tunic blood vessels.
SUBSTANCE: method involves making two incisions in conjunctiva and Tenon's capsule. One incision is done in superoexterior quadrant of eyeball and the second one in the inferointerior one. Two tunnels directed towards posterior eyeball pole are formed between sclera and Tenon's capsule and flexible magnetic polymer implant is placed in each of them. Implant is manufactured as 0.15-0.45 mm thick plate with permanent magnetic field of 0.5-1.5 mTesla units and through reverse profiled magnetization type. The implant has openings having area equal to 0.18-0.52 times implant surface area. The implants are sutured to sclera using interrupted sutures in equatorial region. The implants are not removed.
EFFECT: improved microcirculation conditions in choroid and retina; prolonged treatment effect.
SUBSTANCE: method involves carrying out transpupillary laser coagulation of central avascular zones and transscleral cryocoagulation of peripheral avascular retina zones. 3-4 mm long incisions in conjunctiva and Tenon's capsule are done between sclera and Tenon's capsule in perpendicular to limbus 3-4 mm far from it. Tunnel is built in projection zone of an avascular retina zone between sclera and Tenon's capsule in parallel to the limbus on both sides of the incision. Flexible polymer magnetic implant is extrasclerally introduced into the tunnel in projection zone of an avascular retina zone. The implant has its own permanent magnetic field with magnetic poles alternating on each of sides and permanent magnetic field intensity of 0.5-1.0 mTesla units. The implant is sutured with one of its ends to sclera, and suture is placed on conjunctiva, and anti-oxidant therapy is applied. Magnetic stimulation therapy course is applied 3-4 weeks later. The course combines actions of permanent magnetic field produced by extrasclerally arranged magnetic implant and external rotating permanent magnetic field of 0.30-0.40 mTesla units intensity. Periodicity of external magnetic field action is selected to be 1-2 times per day with external action duration being equal to 3-5 min per 1 session during 10 days. The extrasclerally arranged flexible polymer magnetic implant is removed when treatment course is over. The flexible polymer magnetic implant is manufactured from biologically stable polymer material like one on polypropylene, polyester or polyethylene basis having permanent magnet material powder particles uniformly distributed therein. Magnetic material particles are of samarium-cobalt, neodymium-iron-boron or samarium-iron-nitrogen base.
EFFECT: enhanced effectiveness of prophylactic treatment; prevented severe disease forms progress; released retina edema.
SUBSTANCE: method involves carrying out transpupillary laser avascular zones coagulation. Taurin is dropped into conjunctival cavity at a dose of 1-2 drops into the eye under treatment 5-6 times a day during 7-10 days. 0.02% Histochrome solution is dropped into conjunctival cavity at a dose of 2 drops into the eye under treatment 5-6 times a day during 7-10 days. 0.02% Histochrome solution or 0.02% Emoxipin solution or 1% Retinalamine solution in the amount of 0.4-0.6 ml once a day is parabulbary introduced as antioxidant during 7-10 days. Magnetic stimulation course is applied on the background of conservative therapy to orbital or temporal head region of prematurely born child in any succession using external rotating permanent magnetic field of 0.15-0.40 mTesla units intensity. Periodicity of external magnetic field action is selected to be 1-2 times per day with external action duration being equal to 3-5 min per 1 session during 10 days with magnetic field being 15-30 cm far from orbital or temporal head region of prematurely born child. External permanent magnetic field rotating at constant or variable speed is applied for carrying out magnetic stimulation treatment. Repeated conservative therapy and magnetic stimulation treatment with external rotating permanent magnetic field is additionally applied in 1-3 months. The number of repeated courses is equal to 1-3.
EFFECT: enhanced effectiveness of prophylactic treatment; prevented severe disease forms progress; released retina edema; improved blood circulation in avascular zones.
SUBSTANCE: method involves making corneal self-sealing paracentesis in limbus area, deepening anterior chamber, cutting trabecule and introducing glucocorticosteroid and antibiotic in subconjunctival way. Anterior chamber excavation is carried out by applying trans-scleral vitreous body compression in eyeball equator area. Liquid is discharged from the anterior chamber via the self-sealing paracentesis. The procedure is repeated 2-3 times after its restoration.
EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.
SUBSTANCE: method involves making cataract extraction and implanting intraocular lens. Anterior goniosynechias are additionally separated with spatula and diathermocoagulates are applied in root zone of iris 1-1.5 mm far from anterior chamber angle and distance between the diathermocoagulates being equal to 1.5-2.0 mm in atrophy sector or allover the whole circle in the cases of diffuse iris atrophy with sutures placed.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: method involves carrying out paracentesis at 9-10 o'clock position. Cystostome end piece is introduced through the paracentesis in to the anterior chamber and perforation is done through pupil in the center of the anterior lens capsule. The capsule is pulled towards Zinn's ligament. Triangular flap is formed. The flap is thrown up over the anterior eye lens capsule. Cystostome is applied on the flap. First, 1/3 of anterior continuous circular capsulorhexis is carried out towards Zinn's ligament rupture. Then, capsule forceps is introduced through surgical incision and opposite peripheral capsule edge is fixed. The remaining part of capsulorhexis is carried out with formed flap being removed. Eye lens nucleus hydrodissection is carried out. Capsule ring is implanted. Eye lens nucleus phacoemulsification or cataract laser extraction is carried out.
EFFECT: enhanced effectiveness of treatment; avoided Zinn's ligament and continuous circular capsulorhexis edge rupture.
SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.
EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.
3 cl, 5 dwg