Method for treating purulent cholangitis

FIELD: medicine, abdominal surgery.

SUBSTANCE: one should drain biliary ducts and wash with 0.02%-sodium hypochlorite solution at the dosage of 150-200 ml, by drops, 3-4 times daily for 7-17 d. Moreover, also, during 7-17 d it is necessary to carry out infusion therapy through catheterized portal vein by applying conventional medicinal preparations and introduce 0.04%-sodium hypochlorite per 50-80 ml thrice daily. The innovation provides therapeutic efficiency at applying sodium hypochlorite in lower concentration against well known for sanitation of biliary tract that enables to decrease toxic effect of sodium hypochlorite during therapy conducted.

EFFECT: higher efficiency of therapy.

3 ex, 1 tbl

 

The invention relates to medicine, in particular to abdominal surgery, and is intended for treatment of purulent-destructive processes in the hepatobiliary system.

The number of patients with purulent-destructive processes in the liver, bile ducts increases (Maistrenko N.A., 2000), and an average of 34% in emergency surgery of the abdominal cavity. The most common cause is a gall-stone disease, complicated destructive cholecystitis, acute cholangitis, cholangiogram abscesses, biliary sepsis.

Classical approaches purulent surgery requires that the surgeon, first, to sanitize the site of infection by removal of the affected organ (cholecystectomy) and drainage (external, internal or combined) ductal system.

The second task in the treatment is the impact on the festering hotbed of antibacterial agents. Given the particular liver organ, where there are 2 swimming pools inflow (portal - from the digestive system and blood - vessels of the great circle), for drug delivery, the use of both these paths.

Known successful use of umbilical vein for the correction of homeostasis in burn disease (Achasov NI et al., 1993), in the treatment of pancreatitis, peritonitis, etc. In this case, in addition to conventional treatment, a significant part of infusion the th therapy is performed via the portal pool.

There is a method of treatment of obstructive jaundice, in order to enhance the rehabilitation of the biliary tract copyright certificate №1729494 - authors Vgibsy, Oddlogic (1986). In this way under ultrasound impose percutaneous perhepatic cholangioscopy. Measure the initial pressure of bile. The end of the drainage raise in the mid-axillary line at a height equal to the index of the source pressure. Through cholangioscopy enter furatsilin until the clear dialysate. Then washing is carried out in a mode dosed decompression.

However, percutaneous perhepatic drainage - measure is traumatic enough. Its implementation is possible only at considerable expansion of the ducts (with prolonged jaundice). It is known that furatsilin as an antiseptic, is not efficient enough to pyogenic nature of inflammation (Pods V.I. et al., 1991). He has no necro-, fibrinolytic activity, which complicates the purification of the nidus. In addition, the antimicrobial agent in the group nitrofuranov due to the increase of enzyme activity can cause granulomatosis hepatitis (Viktorov OP et al., 1996), and when the source of liver disease increases the risk of hepatotoxic action (Stratchounski L. C. et al., 2002).

There is a method of treatment of hepatic failure copyright certificate is the construction № 1120980, authors S. Shalimov, Vijuku, USB (1984), according to which the treatment of liver failure is carried out by sampling blood from the portal system, oxygenation and detoxification. The method is as follows: surgically unobrusive on Ostroverkhova or through the peritoneal access exercise transumbilical catheterization of the portal vein Winternitz catheter with a diameter of 4-5 mm Short channel catheter is installed in the mouth of the umbilical vein, and the long channel of the catheter spend 4-5 cm into the portal vein. Blood is collected through a shortened link, using a roller pump serves on the column with sorbent, then in the oxygenator capacity 400 ml, running concurrently with the expansion device, through a long channel back into the portal vein to the liver.

Different length channels Winternitz catheter is used to prevent mixing of blood flow. The use of the oxygenator small capacity and thermal management device enables the process of hemoperfusion thermostabilization perfusion solution with simultaneous enrichment of venous blood with oxygen. The hemoperfusion perform when the blood temperature of 37°at the rate of 80-100 ml for 2-3 hours. The hemoperfusion repeat several times. In the process of hemoperfusion in the oxygenator injected drugs, especially the s intensive care liver failure (glucose, vitamins, gemodez, reopoliglyukin, hormones and others). As the equipment can be used a known design of adsorption columns and perfusion devices.

However, in the analog involve reorganization of the only portal of the basin, and the return of blood carried out only in the left branch, excluding the impact on most (6 of 8 segments) of the liver parenchyma. It is also known that the pressure in the portal vein is low and does not exceed 7 mm RT. Art. and in pathological processes, venous stasis, it can be even lower, making it difficult to draw blood from the portal of the basin, especially in continuous mode the pump.

Blood purification through hemosorbent not remove all toxic substances, antibacterial effect reach oxygenation, which is insufficient for aerobic microorganisms. In addition, perfusion of blood through the sorbent leads to the destruction of formed elements ("dusting coals") (Reshetnikov E.A. et al., 2001). Thus, destroyed the formed elements of blood and particles of sorbent, getting into the portal circulation, can lead to mikrotrombozov (Reshetnikov E.A. et al., 2001).

As the prototype was taken way for intraductal sorption detoxification copyright testimony 1599022 the USSR, MKI 5 a 61 M 1/00, Vpinstruments, Dhamaka, in which the choledoch install external others who click on Robson Vishnevskaya with inflatable cuff, duct to inflate which include inside the main tube and is fixed to its wall. Through the lumen of the main drainage most up equity duct being thin flexible probe, which together with the outer tube output on the anterior abdominal wall. Through the channel of the duct with a syringe inject a pre-determined amount of air that creates an airtight seal of the choledochus. Through the inner catheter with a syringe injected sorbent (suspension of Aerosil in furatsilina) to complete the filling of the bile ducts. After this, the main drainage cover for 20-25 min, while secretiruema liver bile flowing out through internal drainage. At the end of the session sorption drainage opening and through him wash the sorbent by insertion through the inner catheter solution antiseptics.

In the prototype implemented the idea of an active reorganization of the biliary tract, which, however, has some drawbacks. So the introduction of such drainage only if significant expansion of the extrahepatic bile ducts, which in most cases is accompanied by a thinning of the walls thereof, which may be further traumatized when inflating the cuff. With the decline of biliary hypertension difficult to control the adequacy of inflating the cuff when reducing the diameter of the duct.

When introduced and the suspension of the sorbent in the bile ducts is almost impossible to accurately calculate the necessary volume to full fill them. Complete elimination of the injected sorbent is difficult due to its physical properties and the complex architecture of the biliary tract, the remaining fragments of the sorbent cause mikrotravmatizatsiya inflamed mucous ducts. The use of sorbent can partially remove the contents of the ducts without active influence on the inflamed wall, and furatsilin as an antiseptic has clear disadvantages, because it is not efficient enough to pyogenic nature of inflammation and has no necro-, fibrinolytic action (Pods V.I. et al., 1991). In addition, nitrofurans are hepatotoxic drug connection. It is also known that a continuous flow-washing draining has clear advantages over fractional method (Pods V.I. et al., 1991).

To increase the effectiveness of treatment, in particular shortening the rehabilitation of the biliary tract and reduce complications, provide external drainage of the extrahepatic bile ducts by washing with sodium hypochlorite and intraportal infusion of sodium hypochlorite on the background of the introduction of medical products.

The method is as follows.

After rehabilitation purulent-destructive hearth by its removal (cholecystectomy, opening cholangiogram abscess and others) perform choledochotomy, inspect outside - and nutripet cnie ducts according to the standard technique, including choledochoscope. In hepaticopsida install microirrigation, which led to the skin through a separate puncture and fix. Through him enter the sodium hypochlorite drip 150-200 ml of 0.02% solution 3-4 times a day for 7-14 days. The introduction of sodium hypochlorite alternate with the introduction of antibiotics, metrogel, heparin.

In parallel with the above activities are recanalization and catheterization of the umbilical vein with the institution of the end of the catheter, bypassing the mouth valve into the lumen of the portal vein. Intraportal impact exercise as traditional means (antibiotics, metrogel given single doses, and up to 75% of the daily volume of infusion therapy - reopoliglyukin glucosinolates mixture polyionic solutions, albumin and other blood substitutes), and sodium hypochlorite 0,04% solution 50-80 ml 3 times a day. Intraportal infusion therapy carried out from 7 to 14 days, individually varying depending on laboratory data portal and cavalini blood, as well as the dynamics of the General condition of the patient.

Microirrigation removed after a bacteriological study of bile, edema signs of acute cholangitis and improve the General condition of the patient.

Thus, the proposed method is implemented the classical approach in the treatment of purulent-destructive percent of the CCA - removal, drainage and sanitation through the biliary tract. The old rule "where the pus is there a section here as there is nowhere better reflected.

Comparing the proposed method with analogues shows that it has significant differences to achieve a new effect.

If the prototype provides rehabilitation only of the biliary tract, the proposed method simultaneously sanitize and portal pool and biliary tract, which is much more effective and meets the doctrine of modern surgery, allowing efficient use of the principles of local impact. If the prototype for rehabilitation use only sorbent with furatsilina, in the proposed method, therapeutic effect reach the strongest antiseptics - sodium hypochlorite, alternating with the antibiotic, metrogram. In addition, improvements to portal blood flow is realized by the use of reopoligliukina and other infusion of funds. Improvement of microcirculation and normalizes the liver function and stimulates infoproducts. It is known that the normal pressure in the arterial line is 150 mm waters. Art. (120/70 mm Hg), whereas the portal vein pressure of 10 mm of water. senior (7 mm Hg). Due to low pressure in the portal vein, which accounts for 30-40% of the total blood flow, the circulation speed is lower than in the arterial line. This is the anatomic-physiological the practical basis intraportal therapy. The volume of blood flow in the portal pool less system that provides maximum therapeutic effect from the input means as per unit area of target cells drugs have more than the introduction into the General bloodstream. When the accumulation of microbial colonies in hepatoportal the system of conventional routes of administration are less effective due to uneven distribution of antibiotics in the body (due to the presence of biological filters - lungs, kidneys). To achieve an antibacterial effect when intraportal the introduction of antibacterial drugs dose of antibiotics can be reduced by 3-7 times, which reduces the side effects of antibiotic therapy, reduces the risk of intestinal dysbacteriosis, allergic reactions, and plastic wrap, energy and material exchange components to the site of their synthesis and assimilation positive effect on reparative processes in the liver.

Infusion into the portal vein avoids overload of the pulmonary circulation observed in transfusion in cava (especially in patients who are debilitated, elderly with concomitant diseases of the respiratory and cardiovascular systems). Vascular catheters in umbilical Vienna is not prone to thrombosis in the absence of it sports the blood flow.

Clinical examples:

1. Patient Nikitin 63, delivered in the clinic 6.05.2000 was diagnosed with Acute destructive cholecystitis. Liver abscess. The sepsis. In Department of the hospital examination revealed stones in the gall bladder, free fluid in the abdominal cavity, cavity formation in the liver over 15 see When entering a serious condition, the body temperature of 39.2 degrees, interesest skin itches. Breathing casino. When the percussion on the right in the lower sections of dullness. Heart sounds acadeny. AD - 160/90 mm, Pulse 90 / minute. CBC: L - 18,2×109/l, HB - 98 g/l, alpha-amylase - 442, transaminases increased, bilirubin 84 µmol/l, direct 22 µmol/L. NMRI - in the right lobe cavitary liquid education 5, 6, 7, 8 segments of the liver, visible stones in the gallbladder, bile ducts, small seal of the head of the pancreas. When the puncture of the right pleural cavity received 120 ml of serosanguineous fluid. After preoperative preparation for 12 h the attempted operation is an oblique access under endotracheal anesthesia opened the abdominal cavity, there is serosanguineous effusion with an impurity of bile - 400 ml. Around the gall bladder loose infiltration, after the division which found that a gangrenous gallbladder changed, there is a covered perforation hole through which widely the tsya bile with pus. In choledocho determined by palpation dense formation in the gall bladder is also determined by palpation stones. Performed cholecystectomy with separate ligation of the cystic artery and duct. Produced supraduodenal choledochotomy. From choledochus removed 6 of stone diameter of 0.5-2 cm In choledocho muddy bile with putty, pus. Bougie No. 4 free passes in 12-duodenum. Made fibrocholedochoscopy - pyo-fibrinous cholangitis with damage to the ducts of the right lobe. From the ducts of the right lobe - pus mixed with bile. The choledochoscope is 12-duodenum. Ductal system sanitized antiseptics. Implemented separate drainage of the right hepatic duct through the stump of the cystic duct. Performed drainage choledochus by carte. Selected recanalization, catheterized umbilical vein. The catheter is removed through a separate incision in the right upper quadrant. On the lower surface of the liver at the lower edge held puncture liquid of education received pus. The needle abscess opened, deleted, 900 ml of pus mixed with bile. The abscess cavity audited opened pockets, washed with hydrogen peroxide, furatsilinom, drained 2-translucent tube, is fixed to the capsule, the peritoneum, brought out through a separate incision in the right upper quadrant. The peritoneal cavity is drained by Spasokukotsky tubes in the sublattice is börje, iliac regions. Other diseases no. The wound is sutured in layers. The postoperative course was hard. Bacteriological examination of the contents of the abscess revealed E.coli sensitive metrogel, tetracycline, cephalosporins. In the postoperative period the patient was carried out as septic. Through the umbilical vein is injected with a sodium hypochlorite, metrogylum, antibiotics from the group of cephalosporins. Ducts were administered sodium hypochlorite, metrogylum, heparin, antibiotics. The abscess cavity was treated on the principle of flow-suction drainage. For 18 days remained elevated temperature. From cavalini blood on the 6th day crops were sterile. The catheter from the vein removed on the 14th day. After fistulografii of the choledochus drainage was removed on day 15. The catheter choledocho was up to 16 days. The drain in the abscess cavity was up and was retrieved on the 22nd day. Drainage replaced by more subtle, which has stood for another 2 weeks. Discharged after 38 days, partial festering wound. Examined through the year - ultrasound, CT - gross changes in the liver were not observed. The size of the body is reduced, the seal structure in the right lobe.

2. Patient Samsonov, 73, delivered in the hospital with a clinic of obstructive jaundice. Sick since 1944, has been repeatedly examined. Diagnosed with gall-stone disease, chronic calculus the first cholecystitis. From the proposed transaction was refused. When entering a serious condition, severe jaundice (bilirubin: total - 220, direct - 84 µmol/l). When ultrasound gallstones, thickened wall of the gallbladder, stones in the extrahepatic bile ducts. When RPG - many stones in the enlarged common bile duct. The contrast comes in the gall bladder (also defined many of the stones). After examination and preoperative preparation with the growing phenomena of obstructive jaundice and signs of local peritonitis the attempted operation. Access - oblique incision in the right upper quadrant. In the abdominal cavity muddy mixed with bile effusion, gallbladder in infiltration with preprocessor that will apply to the hepato-duodenal ligament. Its elements are not differentiated. The bladder is mobilized. Performed cholecystectomy from the bottom. When processing of the neck of the gall bladder to separate the artery and cystic duct failed. After separation of the gallbladder revealed complete intersection of the common bile duct lower bifurcation at 1 cm From the extrahepatic bile duct enters the bile with cereals, pus. Through a defect in the duct was fibrocholedochoscopy from the distal removed 10 stones. Large duodenal nipple go for bougie No. 4. The ducts washed, ends bile duct mobilized. Diasta is more than 5 mm Further mobilization of the distal stump discovered cystic duct (it is longer than the distal fragment 1 cm). Formed hepatocarcinomas end-to-end. Anastomosis obliquely transverse, oval shaped. Its diameter is 40% greater than the diameter of the hepaticoholedochus. Proximally anastomosis performed hepaticotomy. In the lumen of the installed drainage on Kera. While the proximal branch cut along and inserted in equity ducts. Parallel T-shaped drainage in the choledoch inserted the catheter, the opening in the duct is sealed. The catheter and the drainage outlets through a separate puncture in the abdominal wall. Selected Bagirova catheterized and the umbilical vein. The abdominal cavity sanitized, and drained by Spasokukotsky. Postoperative period was tense. The patient for a long time remained high temperature. Was carried out intraportal therapy was administered antibiotics, reopoliglyukin, sodium hypochlorite, metrogylum. Through the catheter in the bile ducts was also introduced antibiotics, metrogel, sodium hypochlorite, heparin. By the end of 2 weeks normalized body temperature, bilirubin decreased to normal values. The patient began to walk. The catheter from the vein removed. The catheter in the ducts was 17 days. Twice been fistulography. The contrast was entered into the duodenum. Saakov not about the observed. Intrahepatic ducts in the dynamics decreased in size. After 5 weeks from the time of admission the patient was discharged to aftercare in CDH. It was recommended washing ducts through drainage. 2 months after discharge the patient was hospitalized due to accidental extraction of drainage. Been fistulography through the fistula is large duodenal papilla pass, signs of stenosis and no stones. In fistula installed catheter. The patient was discharged. Again the patient is hospitalized after 1.5 years with the clinic of obstructive jaundice. When an ultrasound revealed enlarged outside and vnutripechenochny ducts, suspected stones in the ducts. After discussion, it was performed percutaneous perhepatic drainage ducts. The tubular drainage is freely passed through the area of the anastomosis and end stood at 3 cm from the major duodenal papilla. In the ducts of the shadow stones. For 3 months was carried out drainage, jaundice were stopped, the shadow of the stones remained. It was decided to operate any transduodenal papillosphincterotomy, or imposition biliodigestive anastomosis. Laparotomy with excision of the old scar. Dissected abdominal education with 10 ml of bile, which opens choledocholithiasis hole below the area of the anastomosis. In choledoch drainage. Parallel drainage conducted bougie. Made duodenotomiya papillose ceratomia, the extracted stones from the distal choledochus. Duodenocolic hole stitched, has nasoduodenal probe. Try re-catheterization of umbilical vein unsuccessful. Choledocholithiasis hole sutured. The abdominal cavity drained. The postoperative course was hard. Transitory drainage deleted after 1 month. A year later the patient again hospitalized with clinical jaundice suspected stricture of the choledochus. Therefore decided to re-operate - marked adhesions (when performing intraoperative duodenoscopy endoscopist was seen falling out of the holes 7 large stones). Set to "malignant" form of flow cholelithiasis, with the constant formation of stones in the ducts. On the 7th day the patient died from myocardial infarction. On sections of liver stagnation. Small colagiovanni abscesses in almost all segments, small stones in the intrahepatic prophets. The area of the anastomosis is slightly narrower than the underlying departments.

3. Patient Tarasova 53,, case history No. 1341, was admitted to the hospital urgently with manifestations of obstructive jaundice, acute exacerbation of chronic calculous cholecystitis. When ultrasound in the projection of the gallbladder many echoes, a moderate expansion of the choledochus. Assigned to conservative therapy, examination, during which the diagnosis calcul the EIT cholecystitis confirmed suspected choledocholithiasis. Urgently operated. In operation, the gallbladder is enlarged, inflamed, moderate preprocesses, hepato-duodenal ligament sealed. Choledoch expanded in the lumen of the gallbladder and choledochus palpable stones. Produced cholecystectomy between the neck and bottom due to intrahepatic location of the bubble. In the process of moving the body of the gallbladder from the liver was discovered intrahepatic colagiovanni abscess of about 90 ml of the abscess cavity was washed 3 pigment stone. The bleeding stopped, the abscess cavity sanitized, temporarily Packed. Performed choledochotomy. From choledochus removed 2 large stone and many small ones. Bile mixed with pus, sand, stood out under pressure. Large duodenal papilla go for bougie No. 4. Performed choledochoscope, which found that the pus comes out of the right lobe of the liver, anterior segments. Installed drainage in the choledoch on CERTE, microirrigation held in the right hepatic duct. In the abscess cavity has a separate tube. Bed sutured in places of contact of the edges of the defect. The peritoneal cavity is drained by Spasokukotsky. Tube displayed on the abdominal wall. Isolated and catheterized umbilical vein. The catheter is fixed. Postoperative wound sutured in layers tightly. In reoperations period in the choledoch scheme through microirrigation introduced sodium hypochlorite, antibiotics, metrogel, heparin. Was carried out bacteriological control of bile. Flow-suction drainage of the abscess cavity, intraportal therapy, including antibiotics, metrogel, sodium hypochlorite. Drainage from the abdominal cavity extracted on day 7. Double-implemented control cholangiography through drainage in choledocho and through the drain in the abscess cavity, the cavity of which were reported in the bile ducts. Achieved a complete reorganization of the choledochus. Drainage from the choledochus retrieved on the 18th day of the abscess cavity on the 24th day. Within 2 weeks functioned biliary fistula, which is self-closed.

The histological conclusion phlegmons-ulcer cholecystitis. In bacterial study of the abscess cavity obtained E. coli., sensitive to cephalosporins and aminoglycosides. Intraportal therapy was carried out 12 days. After normalization of temperature, the catheter was removed. Discharged with recovery within 46 days. Partial festering wound. Viewed through the half - healthy.

This method of treatment used in 18 patients, the comparative results of treatment are presented in the table.

Table 1
The results of treatment of patients with purulent-destructive hall is catholicly of the proposed method and group clinical comparison
Indicator of treatment

Type of complication
The proposed methodGroup clinical comparison
n=18%±S%n=20%±S%
Bed-day26±3,8-37±4,6-
Mortality15.56mm±of 5.40420±8,94
Purulent-necrotic complications of the abdominal wall and abdominal cavity15.56mm±of 5.40630±of 10.25
Colagiovanni abscesses--420±8,94
Colagiovanni sepsis--420±8,94
Re-operation15.56mm±of 5.40315±7,98
Biliary fistulas--210±9,49
Biliary pancreatitis--210±9,49

References

1. Naimisaranya, Too. Choledocholithiasis. - SPb.: ALBI - SPb, 2000.

2. Achasov NI System active hir is lieskove treatment tyazheloobozhzhennykh. Bitter: The Volga-Let., kN. , 1972, s.

3. RF patent №1729494. Method for the treatment of obstructive jaundice / Ivshin VG, Lukichev AD On application No. 4705713/14. Declared 19.06.89. MCL And 61 In 17/00. Publ. 30.04.92. B. I. No. 16..

4. Surgical infection: a guide for clinicians (2nd ed., Rev. and supplementary) /Whitrock, Vchost.exe, Yevstratov/AMS USSR. -M.: Medicine, 1991, 560 S.

5. Actorul OP, porokhniak L.A. Poni influence LCV on Penco//Liky. - 1996. No. 1. - P.3-13

6. A practical guide to anti-infective chemotherapy / edited by Listratenkov, Ubbelohde, Snjezana.

7. RF patent №1120980. The method of treatment of hepatic failure / Shalimov S.A., V. Zubkov, Skiba V.V., Shevchenko V.M., Tarpon O.Y, beavers PU On application No. 3462119/28-13. Declared 20.05.82. MCL And 61 In 17/00. Publ. 30.10.84. B. I. No. 40.

8. Reshetnikov E.A., Chobanov M.V., Denisov, A. and Shipilov GF Extracorporeal detoxification in treatment of surgical sepsis. Surgery to them. Pirogov No. 1, 2001.

9. USSR author's certificate No. 1599022, MKI 5 a 61 M 1/00 / Way for intraductal sorption detoxification / Wpincludes, Dhamaka.

The method of treatment of purulent cholangitis, including drainage, irrigation of the bile duct, characterized in that the washing is carried out with 0.02%sodium hypochlorite solution at a dose of 150-200 ml, drip, 3-4 times a day for 7 to 17 days, and after the cat is teresiano portal vein carry out the introduction of 0.04%sodium hypochlorite 50-80 ml 3 times per day during the infusion therapy with the use of traditional medicines is also within 7-14 days.



 

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2 cl, 1 tbl, 1 ex

FIELD: organic chemistry, medicine, pharmacy.

SUBSTANCE: invention relates to derivative of triazaspiro[5.5]undecane of the formula (I): wherein R1 means compound of the formula (1): or (2): wherein G represents a bond, (C1-C4)-alkylene, (C2-C4)-alkenylene or -CO-; ring A represents: (1) C5-10-membered mono- or bicarbocyclic ring or (2) 5-10-membered mono- or bicyclic heterocycle comprising 1-2 nitrogen atoms and/or 1-2 oxygen atoms; substitute R6 means the following values: (1) (C1-C4)-alkyl, (2) halogen atom, (3) nitrile group, (4) trifluoromethyl group and others; R2 represents: (1) (C1-C4)-alkyl, (2) (C2-C4)alkynyl or (3) (C1-C4)-alkyl substituted with a substitute represented in claim 1 of the invention claim; each R3 and R4 represents independently: (1) hydrogen atom, (2) (C1-C4)-alkyl or (3) (C1-C4)-alkyl substituted with 1-2 substituted taken among: (a) Cyc 2 and (b) hydroxy-group (wherein Cyc 2 represents (1) C5-6-membered monocarbocyclic ring or (2) 5-6-membered monocyclic heterocycle comprising 1-2 nitrogen atoms and/or one oxygen atom), or R3 and R4 form in common group of the formula: wherein R26 represents (C1-C4)-alkyl or Cyc 2; R5 represents hydrogen atom or (C1-C4)-alkyl, its quaternary ammonium salt, its N-oxide or its nontoxic salt. Also, invention relates to pharmaceutical composition inhibiting HIV, regulator of chemokine/chemokine receptor and agent used in treatment and prophylaxis of some diseases, such as inflammatory diseases, asthma, atopic dermatitis, nettle rash, allergic diseases, nephritis, hepatitis, arthritis and other diseases that comprise as an active component above described compound of the formula (I) or its quaternary ammonium salt, its N-oxide or its nontoxic salt. Also, invention relates to (3R)-1-butyl-2,5-dioxo-3-((1R)-1-hydroxy-1-cyclohexylmethyl)-9-(4-(4-carboxyphenyloxy)phenylmethyl)-1,4,9-triazaspiro[5.5]undecane or its pharmaceutically acceptable salt and pharmaceutical composition based on thereof, and to (3R)-1-butyl-2,5-dioxo-3-((1R)-1-hydroxy-1-cyclohexylmethyl)-9-(4-(4-carboxyphenyloxy)phenylmethyl)-1,4,9-triazaspiro[5.5]undecane hydrochloride and pharmaceutical composition based on thereof.

EFFECT: valuable medicinal properties of derivative and composition.

16 cl, 32 ex

FIELD: medicine.

SUBSTANCE: the present innovation deals with the ways of extracorporal detoxication and treatment of hepatic failure. The method should be implemented due to introducing albumin-containing solution through a catheter into abdominal cavity at concentration of 30-40 g/l as dialyzing liquid for 2-4 h. This solution should be purified through "Artificial kidney" apparatus, coal sorbent and anion-exchange resin. Perfusion rate of albumin-containing solution in the course of its purification corresponds to 20-30 ml/min. Detoxication cycle with the help of albumin followed by its deligandization should be repeated many times. The innovation provides optimal mode of perfusion and, thus, high rate of toxins elimination through patient's peritoneum and excludes the necessity in applying anticoagulants and expensive "MARS" system.

EFFECT: higher efficiency of therapy.

1 ex

FIELD: medicine, oncology.

SUBSTANCE: method involves autoblood sample taking off in the amount 200-250 ml into a sterile flask with hemopreserving agent "Glugitsir" followed by centrifugation at 1500 rev/min for 30 min. Then supernatant plasma is placed into another sterile flask with a hemopreserving agent and cellular precipitate is reinfused. A single dose of a cytostatic agent is mixed with 10-100 ml of autoplasma, incubated at temperature 37°C for 1 h and administrated through catheter in abdominal cavity by puncture in lower quadrant of abdomen. Procedure is repeated if necessary. Method provides decreasing toxicity of chemotherapy, simple method and uniform distribution of volume of injected preparation for all abdomen cavity. Invention can be used in carrying out chemotherapy of abdomen cavity tumors with ascites.

EFFECT: improved method for treatment.

1 ex

FIELD: medical equipment.

SUBSTANCE: catheter has flexible catheter tube and device for controlled deviation of distal end part of catheter tube. Device for controlled deviation of distal end part of flexible catheter tube is made in form of wire conductor made of springing elastic material. Conductor is capable of free moving along catheter tube into neutral position or initial position. As a result, when conductor is more or less pulled in relatively its initial position, end part of flexible catheter tube does move. Conductor has twisted spiral-shaped end part which when being in neutral or initial position takes place directly in opposition to external end of catheter tube. As a result, when wire conductor is pulled in relatively its initial position inside flexible tube, the end part of tube deflects at adjusted angle under influence of compression power of twisted spiral-shaped end part, which straightens forcedly.

EFFECT: minimal invasive surgery; ability of controlling catheter tube outside patient's body.

5 cl, 2 dwg

FIELD: medicine.

SUBSTANCE: method involves carrying out thoracocentesis, introducing draining tube and fixing it in chest wall. The tube is fixed by introducing corrugated part of device for draining pleural cavity into trocar stiletto cylinder sleeve, moving it into the pleural cavity and fixing corrugation near costal part of parietal pleura. The device has trocar, draining tube, tubular pusher for moving the tube into the pleural cavity and external fixing member. The trocar is manufactured as stiletto having an enveloping cylinder sleeve. The draining tube has corrugation manufactured some distance away from draining tube end, the distance being equal to purulent cavity size determined in X-ray examination. The corrugation collapses when being introduced into the cylinder sleeve. The fixing member is manufactured as plate having a hole tightly embracing the draining tube.

EFFECT: enhanced effectiveness of treatment irrespectively of patient chest wall thickness; reliability and accuracy in tube fixation.

2 cl, 4 dwg

FIELD: medicine; medical engineering.

SUBSTANCE: device has catheter having internal canal, tube arranged in front of distal catheter end and fixing ligature. Reach-through holes are available in catheter wall for connecting the internal canal to environment medium. The fixing tube has reach-through hole in its wall. Intracorporal fixing ligature end is attached to distal end of the fixing tube. Extracorporal end of fixing ligature is introduced into internal canal of the fixing tube via the reach-through hole in fixing tube wall. Ligature is brought out via proximal fixing tube end, drawn through the internal catheter canal and brought out via proximal catheter end having sealing valve. Pusher having connection rod is detachable from the catheter. The fixing tube is shapable as loop holding the catheter in organ cavity. Method involves applying colonoscopy operation. The place intended for setting catheter being reached with endoscope, the fixing tube and catheter are pushed by catheter through instrumental endoscope canal into hollow organ with their distal ends forward. Pusher rod is inserted into proximal catheter end and catheter pushing through the endoscope canal goes on until the fixing tube and distal catheter end exit from endoscope canal into organ cavity. Then, the fixing ligature is pulled in holding the extracorporal end causing the fixing tube to bend as loop in intestine. The so formed loop is brought to the setting place. The loop is pressed against hollow organ wall and the endoscope is carefully withdrawn from the hollow organ. Pushing catheter into hollow organ lumen is kept on with pusher in concurrently slackening ligature out. The proximal catheter end is removed from the endoscope after withdrawing the endoscope from the organ. The pusher is detached from the catheter. Extracorporal fixing ligature end projecting from the proximal catheter end is caught and ligature slack is pulled up. Valve and catheter are attached to external catheter end. The external catheter end is fixed on body.

EFFECT: high accuracy in delivering drugs exactly to pathological focus.

11 cl, 4 dwg

FIELD: medicine.

SUBSTANCE: method involves introducing probe into the stomach via esophagus. Guiding probe in the stomach and intestine is carried out under laparoscopic control. After having placed the working end in the stomach, elastic conductor is introduced via its internal canal. Flexible tube is introduced as far as possible along the external surface into pyloric sphincter and is arranged on the stomach fundus on the greater curvature. Probe with conductor is introduced along the tube via the pyloric sphincter to duodenojejunal curve. The duodenojejunal curve angle is reduced in instrumental way and by turning the patient to the right side. The probe and conductor are brought behind the duodenojejunal curve by applying axial pressure to the external probe end.

EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.

FIELD: medicine, ophthalmology, pediatrics.

SUBSTANCE: method involves irrigation therapy (IT) by retrobulbar catheterization. Before carrying out IT the preparation "Ginkgo biloba" in capsules and age dosage and nasal drops "Semaks" by 1-2 drops for 1 month is prescribed to patient. Then in IT is carried out for 10 days in hospital by administration of cerebrolysin, riboflavin, agapurin, taufon and emoxipine in the dose 0.4 ml of each of them. Preparations are administrated successively, by fractional doses with interval for 2 h in combination with laser-pleoptic treatment at wavelength 0.63 mcm using device "SPEKL" for 10 min, by one procedure per a day for 10 days. After treatment in hospital glutamine and lecithin is prescribed by ambulatory treatment in age doses for 1 month. Method provides the prolonged remission of disease and reduced hospital period due to the complex effect of indicated curative factors on metabolism normalization in nervous cells, their resistance to stress injures, improvement of regenerative and microcirculating processes in eye tissues, frequency-contrast characterization of visual analyzer.

EFFECT: improved treatment method.

1 ex

FIELD: medicine, surgery.

SUBSTANCE: method involves carrying out an antibacterial therapy and additional administration of curative mixture consisting of one part of dimexide, two parts of 0.5% of novocaine solution with antibiotic eliciting high the bacteriostatic activity against microflora in duct secret. Administration of this curative mixture is carried out by catheter into injured duct directly by course 1-2 times. Invention promotes to topical sanitation of mammary gland duct and reducing time of disease. Invention can be used in treatment of galactophoritis.

EFFECT: improved method for treatment.

1 ex

FIELD: oncological diseases.

SUBSTANCE: invention is designed for use in complex treatment of urinary bladder cancer in case of propagation of tumor to sub-epithelium connective tissue. Method comprises transurethral resection and introduction of immune preparations and furacillin solution. Once transurethral resection completed, three-way Foli catheter is transurethrally introduced to patient, through which mixture of standard furacillin solution with 10·106 ME interferon α-2β is injected from the first postoperative day and over following 3-5 postoperative days bringing summary dose of interferon to 50·106 ME.

EFFECT: prevented traumatism of urinary bladder due to single introduction of catheter and assured continuous action of drugs without development of immune complications.

FIELD: medicine, oncology.

SUBSTANCE: the present innovation should be applied at adjuvant chemotherapy in case of tumors of central nervous system. Moreover, while carrying out lumbar puncture it is necessary to perform catheterization of subarachnoidal space. Moreover, one should daily sample liquor at the quantity of 10 ml to be incubated with chemopreparation in vitro for 30 min at 38 C. One should daily introduce chemopreparations upon autoliquor through catheter during the whole period of therapy course. The method enables to choose any mode and duration of endolumbar chemotherapy at its decreased toxicity.

EFFECT: higher efficiency of chemotherapy.

1 ex

FIELD: medicine.

SUBSTANCE: method involves determining required foramen level. Needle is introduced at lumbar, sacral and thoracic segment level in paravertebral way with posterolateral access method and with anterolateral access at the cervical segment level. Tuochi 16-20 needle is applied. The needle is introduced 7-12 cm far from vertebral column median in the direction of intervertebral foramen at an angle of 50-80° to table surface in prone patient position at lumbar, sacral and thoracic segment level. The needle is brought in sliding in lateral direction after it has rested against joint facet. The needle is introduced towards the intervertebral foramen in dorsal patient position. Then, the needle slides from the transverse process in ventral direction. Short-term pain increase being the case, drugs are introduced.

EFFECT: enhanced effectiveness of treatment.

FIELD: medicine, hepatology.

SUBSTANCE: the present innovation deals with treating hepatitis and hepatic cirrhosis of different etiology. For this purpose, in case of viral hepatitis B and C at the stage of active viral replication one should inject sodium hypochlorite solution into central vein at concentration of 300-600 mg/l at the rate of 60 drops/min, per about 200-400 ml every other day, about 5-7 procedures/course; in case of viral hepatitis B and C beyond the stage of active viral replication one should inject sodium hypochlorite solution into peripheral vein at concentration of 300 mg/l at the rate of 30 drops/min per about 200-400 ml every other day, about 5-7 procedures/course; in case of hepatitis of non-viral etiology one should inject sodium hypochlorite solution into peripheral vein at concentration of about 200-300 mg/l at the rate of 30 drops/min, per about 200-400 ml daily, about 3-5 procedures/course; in case of hepatic cirrhosis it is necessary to inject sodium hypochlorite solution into peripheral vein at concentration of about 100-200 mg/l at the rate of 40 drops/min, per about 200-400 ml every other day, about 3-5 procedures/course. The innovation suggested provides increased efficiency of detoxication and anti-viral impact due to differentiated matching both the dosages and modes of preparation injection at different forms of hepatic lesions.

EFFECT: higher efficiency of therapy.

2 ex, 1 tbl

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