Method for treating background and precancer uterine cervix disease cases

FIELD: medicine.

SUBSTANCE: method involves covering ectocervix with Photodithazine photosensibilizer produced on the basis of glycamine chlorine salt E6 with active substance concentration being equal to 0.3-0.5% and holding it for 2 h. Laser radiation treatment is applied in continuous mode at wavelength of 660 nm and energy density of 80-200 J/cm2 supplied to wound during 8-20 min.

EFFECT: enhanced effectiveness of treatment; reduced risk of allergic response and adverse side effects.

 

The invention relates to medicine, specifically to gynecology, particularly to a method of photodynamic therapy background and precancerous diseases of the cervix.

In the last decade for the treatment of cervical pathology actively used electrosurgical treatment method (VI Prilepskaya "diseases of cervix, vagina, vulva M., "Medpress", 2000, s-176).

How traumatic, the most frequent complications include stenosis of the cervical canal, local bleeding in the postoperative period, implantation endometriosis, menstrual cycle and reproductive function.

Photodynamic therapy (PDT) is a relatively new method of treatment of various diseases. Basically PDT is used to treat neoplastic and non-neoplastic diseases. The basis for the use of PDT data on the selective accumulation and long delay photosensitizer cells with high proliferative activity. Under the influence of laser radiation develops photochemical reaction with the release of singlet oxygen and active radicals that are cytotoxic for pathological tissue (F. W., Balusek, F, Balusek and other Medical laterolog", St. Petersburg, NGO, Peace and family 95", LLC "Interline", 2000, p.129-143).

There is a method of treatment of benign diseases - purulent the wounds of soft tissues, consisting in the fact that the wound impose napkin on the basis of dialdehydes containing the biologically active drug photosensibilisation "photosense" on the basis of aluminum phthalocyanine, and after keeping the cloth on the wound within 24 h conduct irradiation of wounds red light emitted from the solid-state laser yttrium aluminate, with twice the frequency and wavelength of 670 nm or non-laser light source wide emission band of 600-700 nm and a wavelength of 670 nm (U.S. Pat. Of the Russian Federation No. 2164427, MCI And 61 N 5/067, publ. 27.03.2001).

The disadvantages of this method include the complexity of the procedure is the necessity of using napkins of a certain type (based on dialdehydes), duration keeping the cloth on the wound, the impossibility of localization of the photosensitizer within the wound surface.

There is a method of treatment of atypical endometrial hyperplasia, consisting in the fact that the uterine cavity is injected photosensitizer, for example a solution of aminolevulinic acid. Perform visual diagnosis of mucous membrane and carry out the destruction of the mucosa by vaporization with a capacity of 240-300 watts. The magnitude of the power change in the process of decomposition depending on the degree of destruction of the mucous membrane.

(U.S. Pat. Of the Russian Federation No. 2212202, MCI And 61 In 17/42, publ. 20.09.2003).

The disadvantages of the treatment of atypical guy is eclatee endometrium by introducing into the uterus of a photosensitizer is incomplete ablation of the endometrium, which is manifested by the occurrence of recurrent uterine bleeding due to the difficulty of delay of the photosensitizer in the uterine cavity for 1-6 hours.

The invention solves the problem of creating a method of treatment of background and precancerous diseases of the cervix method of photodynamic therapy.

The problem is solved due to the fact that the method of treatment background and precancerous diseases of the cervix comprises applying to the pathological area ectocervical gel photosensitizer "Photoditazine" based glutaminol salt of chlorin E6 when the concentration of the active substance of 0.3-0.5%, keeping 2 hours and the irradiation of the laser in continuous mode at a wavelength of 660 nm and density supplied to the wound energy 80-200 j/cm2for 8-20 minutes.

Gel-based glutaminol salt of chlorin E6 "Photoditazine (TU 64-19-162-92) comply with sanitary regulations SanPiN 1.2.681-97.

The method is as follows.

After admission of the patient to the hospital and required additional research and refinement of the diagnosis of the pathological area of the ectocervix with a cotton ball applied photosensitizer gel Photoditazine" (produced by "Veta Grande") at a concentration of active ingredient in the drug of 0.3-0.5%. Application of the gel Photoditazine" with the concentration of the active substance is less than 0.3% causes nedostatochnosty. In the treatment of background diseases of the cervix, the optimum concentration of the active substance in the photosensitizer "Photoditazine" is 0.3%, which provides gentle photodestruction pathological areas of the epithelium without the formation of scar tissue that is most important when treating women of reproductive age. The use of photosensitizer "Photoditazine" with the concentration of the active substance more than 0.3% is reasonable when cervical dysplasia the II-III century, when you need in-depth photo-destruction of abnormal tissue. Withstands photosensibility 2 hours (below).

Withstand the photosensitizer 2 hours. At smaller time gel Photoditazine" do not have time to penetrate into the tissue of the wound and increase the exposure time is impractical because of the accumulation of gel in the wound enough 2 hours. This is followed by laser irradiation wounds at a wavelength of 660 nm, output power of 1.0 W and density supplied to the wound energy 80-200 j/cm2for 8-20 minutes using the apparatus "ATCUS-2" (CJSC "Semiconductor devices", St. Petersburg). In the treatment of uncomplicated ectopia enough energy density of 80 j/cm2and exposure time of 8-10 minutes. Complicated forms ectopia, leukoplakia and dysplasia require increased density settings energy up to 200 j/cm2and exposure time to 20 minutes.

When conducting a PDT photosensitizer "Photoditazine" in the form of a gel side effects or allergic reactions were observed. This method is quite radical, but at the same time sparing with preservation of anatomical and functional usefulness of the cervix.

The invention is illustrated by the examples.

Example 1.

Patient K., aged 22, was admitted to hospital with a diagnosis of ectopia of the cervix, which was first discovered 8 months ago. For specification of the diagnosis result in an extended coloscopy, cytological examination of smears from the surface of the cervix and cervical canal. To identify concomitant infection conducted bacterioscopic and bacteriological examination.

2 hours before the start of laser irradiation on the area ectopia of the cervix with a cotton ball applied photosensitizer - gel "Photoditazine" when the concentration of the active substance of 0.3%. Laser effect on the area ectopia carried out using the semiconductor apparatus Aktus-2 in a continuous mode at a wavelength of 660 nm, output power of 1.0 W and density dive torches etc the ima to the wound energy 80 j/cm 2within 8 minutes. Beginning epithelialization is celebrated on the 5th day. After 4 weeks - complete epithelialization.

Example 2.

Patient Z., 42 years old, was admitted again to hospital with a diagnosis of leukoplakia of cervix uteri, which revealed for the first time 3 months ago. When colostomies study on the rear lip discovered an extensive area of leukoplakia with indistinct contours. After processing the surface of the cervix with a solution of 3%acetic acid atypia vessels not identified. After coloring the surface of the cervix with Lugol solution defined yadegarynia plot over the entire surface of the rear lip. Histological examination of the biopsy of the cervix, which was performed during the first admission to the hospital revealed a simple leukoplakia.

2 hours before the start of laser irradiation on the pathological area of the ectocervix with a cotton ball applied photosensitizer - gel "Photoditazine" when the concentration of the active substance of 0.3%. Laser treatment of pathological area is done using the semiconductor apparatus "Aktus-2 in a continuous mode at a wavelength of 660 nm, output power 1 W and density applied to the wound to the energy of 100 j/cm2within 15 minutes. During the PDT side effects were noted. Rejection altered epithelium and the beginning of epithelialization observed in 6-7 days. is olna epithelialization observed after 6 weeks.

Example 3.

Patient L., aged 45, has been re-diagnosed with cervical dysplasia I-II century the Diagnosis was confirmed by the histological study, which was conducted during the first admission to the hospital. When colostomies study the surface of the cervix with the phenomena of incomplete transformation zone. When processing a solution of 3%acetic acid is determined by punctate vessels on the rear lip. After treatment with Lugol solution the entire surface of the cervix acquired mosaic coloring.

2 hours before the start of laser irradiation on the pathological area of the ectocervix with a cotton ball applied photosensitizer - gel "Photoditazine" when the concentration of the active substance of 0.5%. Laser treatment of pathological area is done using the semiconductor apparatus "Aktus-2 in a continuous mode at a wavelength of 660 nm, output power of 1.0 W and density supplied to the wound energy of 200 j/cm2within 20 minutes. Complete epithelialization was observed after 6 weeks.

Treatment background and precancerous diseases of the cervix, including the application of the pathological area of the ectocervix gel photosensitizer "Photoditazine" based glutaminol salt of chlorin E6 when the concentration of the active substance of 0.3-0.5%, keeping 2 h and irradiation with the laser in continuous mode at length the wavelength of 660 nm and density supplied to the wound energy 80-200 j/cm 2for 8-20 minutes



 

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FIELD: medicine.

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2 cl

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3 cl

FIELD: medicine.

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2 cl

FIELD: medicine.

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EFFECT: dosed action upon ciliary body; reduced risk of traumatic complications; stable ophthalmotonus compensation; improved microcirculation in optic nerve; improved vision function.

2 cl

FIELD: medicine.

SUBSTANCE: method involves applying transpupillary irradiation of intraocular neoplasm with low intensity laser radiation of wavelength equal to 633 nm at a dose of 2.5 J or wavelength of 890 nm at a dose of 1.2 J. Then, chlorine row photosensitizer is intravenously introduced at a dose of 0.8-1.1 mg/kg. Spectral fluorescence diagnostic of photosensitizer accumulation is carried out 15-20 min later in the neoplasm. Intraocular neoplasm fluorescence being observed compared to the surrounding tissue, the neoplasm is transpupillary irradiated using laser radiation of wavelength corresponding to maximum light emission absorption on photosensitizer part and power density equal to 100-120 J/cm2. Then, tunnel is formed in subtenon space and neoplasm thermotherapy is trans-sclerally done.

EFFECT: enhanced effectiveness of treatment; dosed treatment course applied; completely stopped tumor growth.

2 cl

FIELD: medicine.

SUBSTANCE: method involves intrastromally introducing chlorine row photosensitizer into tumor in 0.35-0.5% solution in the amount of 0.1-0.5 ml, intravitreally applying to tumor in 1.0-2.0% gel in the amount of 0.2-0.3 ml and intravenously introducing at a dose of 0.5-0.8 mg/kg. Intravenous laser irradiation with wavelength corresponding to maximum light emission absorption on photosensitizer part is concurrently applied with Intravenous photosensitizer introduction during 10-15 min with power of 20-500 mW. Intravenous laser irradiation being over, spectral fluorescence diagnostic of neoplasm is applied. Intravitreal laser irradiation of neoplasm is carried out with wavelength corresponding to maximum light emission absorption on photosensitizer part under power density of 100-120 J/cm2. Then, intraocular neoplasm is intravitreally removed. Retina is smoothed with perfluororganic compound. Photosensitizer is repeatedly introduced 7-14 days later after removing neoplasm and spectral fluorescence diagnostic is applied. The fluorescent regions are exposed to laser radiation with wavelength corresponding to maximum light emission absorption on photosensitizer part and power density equal to 50-80 J/cm2. The perfluororganic compound is substituted with silicon oil. Intravenous photosensitizer introduction and intravenous laser irradiation of blood are repeated 3 months later.

EFFECT: enabled complete intraocular neoplasm removal; reduced risk of viable tumor cells being retained in operation field or disseminated; reduced risk of relapses and metastases applied; completely stopped tumor growth.

2 cl

FIELD: medicine.

SUBSTANCE: invention proposes a method for inhibition of chorionic neovascularization. Method involves irradiation of undesirable novel vascular reticulum in combination with photosensitive agent (porphyrine) and an anti-angiogenic agent taken among antagonist of phospholipase A2, inhibitor of complex kappa B, inhibitor of the growth hormone, inhibitor of insulin-like growth factor-1, inhibitor of cyclooxygenase II, inhibitor of protein kinase C (stautosporin PKC 412) and inhibitor of angiotensin II. The claimed combined treatment provides potentiation of effect of adjunctive photodynamic therapy in combination with enhanced safety.

EFFECT: improved treatment method.

7 cl

FIELD: medicine.

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

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