Method of treating patients suffering form nepholythiasis

FIELD: medicine; urology.

SUBSTANCE: IR-range laser radiation is applied locally at projection of increment in kidney. 12 procedures of laser distant lithotripsy are given with the following frequencies: first to fifth procedures at 28-32 kHz, sixth to eighth procedures at 24 kHz, ninth to tenth procedures at 20 kHz, eleventh to twelfth procedures at frequency of 16 kHz. Shape of pulse for 1-2 procedures is rectangular, for 3-4 procedures - sinusoidal, 5-6 procedures - triangular, and 7-12 procedures - rectangular. All the procedures are performed till standard distant lithotripsy.

EFFECT: ability of reducing sizes of stone; reduced inflammatory changes in kidneys.

2 ex

 

The invention relates to medicine, namely to urology.

Despite the well-known successes in the field of minimally invasive treatment of kidney stones (ICD), is important to search for the least invasive treatment methods. In this respect, of great interest is the method of complex medical and laser therapy of patients with chronic calculous pyelonephritis as monotherapy and in combination with standard ESWL apparatus Lithate-P. There are reports of litolitic the impact of low-energy radiation in the infrared range (Evstigneev, A.R., hares I.M. 1999). Laser therapeutic apparatus, working on gallium arsenide, generating radiation wavelength of 0.89 μm, average pulse power up to 5 W and a frequency of 33 kHz ("Beehive-2 KM" "Lithate"), causing the vibration of the stones and have them alternating light pressure and acceleration of fragmentation of concrements. According to this method, per unit time depending on the frequency of the radiation and form supplied pulse changes the density of ureteral stones. According to some authors (Maksutov GS, Fomichev V.I., Eliseenko VI - 1999) variable acceleration is causing the vibration of the stone and contributing to the loosening of the structure of the stone.

This method is taken as a prototype ("Complex therapy of chronic cholecystitis with p the power of low-energy laser radiation of the visible infrared range", in Proc. of "Actual problems of clinical medicine"). In the work has a positive effect on long-term use of laser radiation of the visible and IR range when exposed to the area of projection of the stones of the gall bladder.

The aim of the invention is to increase the efficiency lithotripsy, reducing the frequency of postoperative complications.

The essence of the proposed method.

In the preoperative period, on a background of antibacterial therapy, conducted 12 sessions of ESWL apparatus Beehive-2 KM", "Lithate", the procedure is painless, performed daily for 15 min, the frequency of exposure varied from 33000 to 16 kHz, the wavelength of 0.89 μm, the pulse power of 5 watts. In our studies used laser therapy system "Hive-2 KM", "Lithate", with a frequency of 1 through 5 of the procedure 28-32 kHz, 6-8 procedure 24 kHz, 9-10 procedure 20 kHz, 11-12 procedure 16 kHz. Pulse shape: 1-2 treatments - rectangular, 3-4 sinusoidal, 5-6 triangular and 7-12 rectangular. The patient lies on his stomach, the influence exerted by the contact method on the area of projection of the kidneys at the back of axillary lines with an exposure of 15 minutes. Laser therapy was performed on the background of drug therapy (antispasmodics, analgesics, anticipat sites, desensibiliziruyuschee tools, colexon (xidian), urolithic - Kahn, the French, ciston, singalling shed) 36 patients aged from 25 to 68 years. The control group consisted of 20 patients who did not receive laser therapy. Monitoring the effectiveness of treatment was performed using rengenoradiologicheskogo studies, ultrasound of the kidneys, laboratory tests of urine, blood. Pain and functional symptoms cropped in 26 patients of main group 3 of the procedures, normalization of blood counts observed in 5-7 procedure. After treatment, including 8-12 daily procedures, there has been a decrease in the size of the stone, reducing the inflammatory changes in the parenchyma of the kidney in 18 patients. When performing subsequent standard lithotripsy apparatus LITHATE-P ", managed to disintegrate the stones at a lower power pulses (of 14.0 to 17.5 watts) and the number of pulses (up to 3000 pulses), shows good fragmentation of ureteral stones.

The use of less invasive method Lithate-2 KM "BEEHIVE" at the stage of preparation for the standard ESWL on Lithate-P reduced the frequency of acute inflammatory complications of the kidneys more than doubled (up to 2.5% of cases). Obstruction of the ureter fragments of the calculus was observed in 11.2% of patients. Hematuria was observed in less than 60% of patients. This result ESWL apparently due to the decrease in the density of calculus, a small stone fragmentation when is the reduction of power pulses and the total number of pulses, decreased activity of the inflammatory process.

A specific example of the method.

Example 1. The patient was admitted with complaints of pain in the right lumbar region of a blunt character, on the temperature increase to 38.2-38,5°changes in o/and urine (leukocytes, erythrocytes, and so on). Sick about 2 weeks. From the anamnesis it is known that he was about 3 years old.

The patient is examined, diagnosed with kidney stones, the stone in right kidney (1.5 cm), chronic pyelonephritis. Started antibacterial and symptomatic therapy. At the same time used laser therapy using the apparatus of the Beehive-2 KM "Lithate" with a frequency of 1 through 5 of the procedure 28-32 kHz, 6-8 procedure 24 kHz, 9-10 procedure 20 kHz, 11-12 procedure 16 kHz. Pulse shape: 1-2 treatments - rectangular, 3-4 sinusoidal, 5-6 triangular and 7-12 rectangular. The patient lies on his stomach, the influence exerted by the contact method on the area of projection of the kidneys in the back-axillary line on the right with an exposure of 15 minutes With 3 sessions normalized temperature, decreased inflammatory response to 8 session indicators were normalized urine. After 10 session performed ultrasound - marked decrease in the size of the stone (1.2 cm), reducing the inflammatory response of the kidney parenchyma. On day 12 completed ESWL apparatus LITHATE-P" (power of the pulse wave from of 14.0 to 17.0 W, 2700 pulses in gently and operating mode) calculus completely disintegrated. Yourself away small fragments with a diameter of 0,1-0,2-0,3 see at follow-up At 1 month concretions in the urinary tract is not revealed.

Example 2. The patient was admitted with complaints paroxysmal pain in the right lumbar region, fever up to 39.5°, nausea, vomiting, General weakness. During the examination the patient is diagnosed with kidney stones, multiple stones in right kidney, gidroenergetichesky transformation right, exacerbation of chronic pyelonephritis. The patient underwent an operation of nephrolithotomy right. In connection with bleeding from the kidneys to remove all the stones failed. He was one of the calculus of dimensions 1.1×0,9 see the Patient in the p/o period was conducted anti-inflammatory and symptomatic therapy using laser radiation apparatus Hive 2 KM "Lithate" with a frequency of 1 through 5 of the procedure 32 kHz, 6-8 procedure 28 kHz, 9-10 procedure 24 kHz, 11-12 procedure 20 kHz. Pulse shape: 1-2 treatments - rectangular, 3-5 sinusoidal, 6-8 triangular and 8-12 - rectangular. During treatment, the patient lies on his stomach, the influence exerted by the contact method on the area of projection of the kidneys in the back-axillary line on the right with an exposure of 15 minutes With 4 sessions normalized temperature, decreased pain and inflammatory response to 10 session indicators were normalized urine. After 11 session vol is Leno ultrasound marked reduction in the size of stone (up to 0.8 cm) reduction of inflammatory reaction of the parenchyma of the kidneys, reducing kidney pelvis. On day 12 completed ESWL (power pulse waves from 13.8 to 17.8 watts, 2800 pulses, in a sparing mode) calculus completely disintegrated. Independently and nephrostome leave small fragments with a diameter of from 0.1 to 0.3 see At follow-up after 15 days, concretions in the urinary tract is not revealed, nephrostome removed.

The usefulness of the proposed method of treatment.

Remote lithotripsy (ESWL), like any other surgery is not without complications, the frequency of which is determined by the quality of the clinical examination of patients, the justification of the indications for ESWL, the adequacy of pre - and postoperative antibiotic therapy, the selection of the optimal technique and the method of lithotripsy. The combined use of the apparatus Hive 2 KM "Lithate" and "LITHATE-P" can significantly improve the results of lithotripsy and to reduce the frequency of acute inflammatory complications of the kidneys and upper urinary tract, significantly reduce the time of rehabilitation.

Sources of information

1. GRES A.A., Mokhort VA, Sufficient NI, Nenartovich B.C. extracorporeal shock wave lithotripsy apparatus "Lithostar Plus. Abstracts of the First Russian Symposium on remote is th lithotripsy in urology. Moscow 1992, p.21-22.

2. Trapeznikov F, Dutov CENTURY Modern aspects of nephrolithotripsy. The materials of the Plenum of the rights. Grew up with. society of urology, Moscow, 1998, s.

3. Bulls I.M., Rubtsova H. Qualitative characteristic density of stones and remote nephroureterectomy. Materials of the Plenum of the rights. Grew up with. society of urology, Moscow, 1998, s-285.

4. Farberow VA, Holenda I.L., Kudashov S.A., Minin, V., Ovchinnikov V.V., Eisenach AV Damaging effect of extracorporeal shock wave lithotripsy. J. Urology, 2001, p.32-34.

5. Maksutov GS, Fomichev V.I., Eliseenko VI Complex therapy of chronic cholecystitis with low-energy laser radiation of the visible and IR range. Actual problems of clinical medicine. Moscow, 1999, s-84 prototype.

A method of treatment of nephrolithiasis, including the use of laser radiation in the infrared range locally on the projection of ureteral stones in the kidney, characterized in that hold 12 sessions of laser lithotripsy with a frequency: 1 to 5 treatments 28-32 kHz, 6-8 procedure 24 kHz, 9-10 procedure 20 kHz, 11-12 procedure 16 kHz, pulse shape: 1-2 treatments - rectangular, 3-4 procedure - sinusoidal, 5-6 - triangular and with 7-12 - rectangular, and these procedures are performed to standard lithotripsy.



 

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1 ex

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1 ex

FIELD: medicine.

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FIELD: medicine.

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6 cl

FIELD: medicine.

SUBSTANCE: method involves filling vitreous cavity with perfluororganic compound. Two electrodes manufactured from platinum group metal are intravitreally, transretinally introduced into intraocular neoplasm. Electrochemical destruction is carried out with current intensity of 10-100 mA during 1-10 min in changing electrodes polarity and their position in the intraocular neoplasm space, and the electrodes are removed. 0.1-1% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, intravitreous, transretinal laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2 in perfluororganic compound medium. The transformed retina and tumor destruction products are intravitreally removed with perfluororganic compound volume being compensated with its additional introduction. Boundary-making endolasercoagulation of retinotomy area is carried out. The perfluororganic compound is substituted with silicon oil. The operation is ended in placing sutures over sclerotmy areas and over conjunctiva. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity. Platinum, iridium or rhodium are used as the platinum group metals.

EFFECT: complete destruction of neoplasm; reduced dissemination risk.

6 cl, 12 dwg

FIELD: medicine, applicable for stopping of pains of various nature.

SUBSTANCE: the device has a quantum-mechanical oscillator located in a casing, magnet, vessel for medicinal agent and a hollow cylinder. The magnet is installed between the oscillator and the vessel. Positioned in the vessel is a hollow cylinder having through holes on its surface.

EFFECT: quick and absolute anestesia.

2 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: method involves administering laser radiation therapy once a day using low intensity pulsating radiation of wavelength equal to 890nmand power density of 0.03 mW/cm2. Injured organ projection to frontal abdominal wall is exposed to radiation at the first laser therapy stage in two fields acting upon each field for 2 min with radiation pulse succession frequency equal to 80 Hz in applying stable contact-type method. Total treatment dose on two fields is equal to 0.008 J/cm2. The second laser therapy stage begins immediately after having finished the first one in applying radiation along the large intestine path using labile contact-type method in a way that radiation pulse succession frequency equal to 80 Hz is applied first during 1 min and then frequencies of 600, 150 and 300 Hz are applied also during 1 min, respectively. Total treatment dose is equal to 0.032 J/cm2 at the second stage. Total treatment dose is equal to 0.04 J/cm2 at both stages.

EFFECT: enhanced effectiveness in inhibiting dysbacteriosis; reduced frequency of postoperative complications.

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