Method of treating macular oedemas of various geneses
SUBSTANCE: invention refers to medicine, namely to ophthalmology, and can be used in treating the patients with macular oedemas of various geneses. That is ensured by the therapy that starts with 6 sessions of plasma exchange every 2 days. It is followed by a single intravitreal introduction of antivasoproliferative preparation Avastin in dosage 1.25 mg or Lucentis in dosage 0.5 mg.
EFFECT: method allows improving clinical effectiveness combined with reduced intravitreal introduction of the antivasoproliferative preparations, due to involving pathogenetic mechanisms, namely elimination of pathological immune complexes, stabilisation of pro- and anti-inflammatory cytokines.
2 cl, 2 ex
The invention relates to medicine, namely to ophthalmology, and can be used in the treatment of macular edema of various origins.
Macular edema in such diseases as age-related macular degeneration (AMD), diabetic retinopathy, occlusion of the Central retinal vein, is one of the most common causes of sudden vision loss leading to disability in the elderly population (Abas Khadija, 1989; Hakobyan, B.C., 2004; Alekseeva L.L. and others, 1996; Astakhov US and others, 2004). Among the reasons for the development of macular edema detected by factors such as rheological, immunological, hypoxic, metabolic, hormonal, genetic and other, causing damage to the walls of the capillaries of the retina, vascular permeability and growth of newly formed vessels. The main method of treatment of macular edema today is laser coagulation in various modifications (Astakhov YU.S., 2000;
Balashevich L.I., 2005; Izmailov A.S., 2004; Katsnelson L.A., 1980). The method allows to achieve stabilization of the pathological process, but it has no effect on the pathogenic mechanisms of this disease. It is also difficult to produce coagulation with the lack of transparency of the optical media.
Among other methods of treatment are surgical methods (removal neovascular the second membrane, the excess traction of the posterior hyaloid membrane, vitrectomy). The disadvantages of surgical treatment methods are a violation of the anatomical structures of the eye, a considerable amount of interference in the vitreous body, the induction of proliferative vitreoretinopathy.
There are medical methods (antioxidant therapy, therapy aimed at improving the rheological properties of blood and hematocrit, immunomodulatory therapy). However, medical procedures does not affect neovascular membrane, is not the elimination of toxins and pathological immune complexes.
There is a way to treat the wet form of AMD, including intravitreal injections of the drug Avastin (bevacizumab) at a dose of 1.25 mg (Aviko, Averaging, Swieszkowski and other "First experience with the drug Avastin in the treatment of the wet form of age-related macular degeneration" // Modern technologies of treatment of vitreoretinal pathology - 2007. The collection of scientific articles of materials of scientific-practical conference (Moscow, March 23, 2007) / Under the editorship of theoretical information. Moscow, 2007, P.54-58). The disadvantage of this method is the short duration of drug action that requires multiple repeated injections. Also, the method has no effect on the causes of the pathological process (the imbalance of Pro - and FR is vospaliteleny cytokines, pathological immune complexes, impaired microcirculation, metabolism).
Closest to the claimed method is a method of treatment of maculopathy various origins and anterior ischemic opticoat method of plasmapheresis (United States Patent 6245038, 1997). With this method of treatment positive clinical effect was achieved by improving the retinal microcirculation, improve the rheological properties of blood by apheresis red blood cells in combination with the elimination of fibrinogen and protein of high molecular weight. However, the method does not affect the subretinal neovascularization
The objective of the invention is to increase the effectiveness of treatment and reducing the frequency of intravitreal injections antimajoritarian drugs due to the elimination from the blood pathological immune complexes, cytokines involved in angiogenesis and increases vascular permeability, improve choroidal and retinal microcirculation.
The technical result in the use of the invention is the elimination of pathological immune complexes, stabilization of Pro - and anti-inflammatory cytokines, reduce the frequency of intravitreal injection antimajoritarian drug.
The proposed method for the treatment of macular edema as follows. On the first the second stage, extracorporeal plasmapheresis, in which in the absence of contraindications side of the blood coagulation system, General condition of the patient hold the blood of the patient in the amount of 450-750 ml disposable plastic container with a preservative, an intravenous infusion of 200-400 ml isotonic. The container is placed in a centrifuge, where at a speed of 2500 rpm for 15 minutes sephirot, when removing the container from the centrifuge plasma was removed and the cell mass is added 150-200 ml of physiological solution, then do reinfusion diluted cell mass.
At the second stage, intravitreal injections antimajoritarian drugs (Avastin at a dose of 1.25 mg, Lucentis at a dose of 0.5 mg) through the flat part of the ciliary body in the conditions of an operating room under local anesthesia with 2% 2 ml lidocaine retrobulbarno. Prescribed antibiotics the day before surgery and five days after.
The follow-up period patients are week after administration of the drug, every month for 6 months. Evaluation results carried out by visual acuity, Central visual field, data HRT, ultrasound examination of the eyeball, immunological methods tears and blood of patients at each visit the patient's ophthalmologist. Next, if there maculare the swelling, subretinal fluid or permanent separation of the pigment epithelium is repeated injection of a drug or periods of observation extend, if determined obliteration neovascular membrane resorption of edema.
When the claimed method of treatment, the frequency of intravitreal injections is reduced due to the elimination from the blood pathological immune complexes, cytokines involved in angiogenesis and increases vascular permeability. Also improved the rheological properties of blood, the hematocrit, which improves choroidal and retinal microcirculation.
In the available scientific and medical and patent literature not found information about the popularity of the method for the treatment of macular edema, including exchange plasmapheresis course of 6 sessions conducted with an interval of 2 days, a single intravitreal injections antimajoritarian agent. Thus, the claimed invention meets the criterion of "novelty".
The authors proved that the conduct of the exchange plasmapheresis removes the imbalance of Pro - and anti-inflammatory cytokines contributes to the elimination from the blood of pathological immune complexes, and the subsequent single intravitreal injections antimajoritarian of drug resistant E. the effect of reducing swelling and reduction of neovascularization. Thus, the claimed invention meets the criterion of "inventive step".
The invention is illustrated by the following clinical examples.
Patient W., 76 years old, diagnosis: OD - Age-related macular degeneration, dry form. The artiphakia. OS - Age-related macular degeneration, wet form. Immature age-related cataract. Visual acuity D=0.2 NK/ OS=0.01 Nicholas
OS - In the macular area, a significant prominence retinal exudative detachment of the neuroepithelium, neovascularization.
The data of ultrasound scan OS - B region of the optic nerve disc reticulated shell locally prominenet in the vitreous body to 2.0 mm
Data HRT OS - laser scan redintegratio the macular region are rendered nonuniform nonuniform reflexivity areas, parafoveal prominere to 1000 μm. Indicators thickness increased to 610 μm at the bottom, up to 862 ám in the forward sector. The swelling index increased to 5.03. The patient was treated by the proposed method.
In the first stage, held the rate of exchange plasmapheresis, which consisted of 6 sessions conducted with an interval of 2 days. Upon completion of the course the patient in the operating conditions under local anesthesia in the left eye intravitreal introduced 1.25 mg Avastin. Parabulbarno entered antibiotic solution with dexatrim. Epibulbar Intellinova the antibiotic solution. Antibiotic therapy was administered the day before surgery and five days after.
When viewed in the first day after surgery: OS - visual acuity = 0.01 (not correcting), the transparent cornea, anterior chamber average depth of the lens partly cloudy in the vitreal cavity slight strengthening of destruction, in the macular area of prominence retina, subretinal exudation, neovascularization.
At the control examination after 1 week visual acuity OS=0.03 (not correcting), the transparent cornea, anterior chamber medium, the lens partly cloudy in the vitreous body of minor destruction, retin-a slightly prominenet in the vitreous body in the area of the macula, marked resorption of subretinal fluid and neovascularization in the macular area, Druze and redistribution of pigment epithelium.
The data of ultrasound scan OS - In the area of the optic nerve disc reticulated shell locally prominenet in the vitreous body at 1.0 mm
Data HRT OS - laser scan redintegratio macular area in the dynamics reveals the decrease of thickness up to 678 μm in the lower sector of up to 508 microns. The swelling index is reduced to 4.26.
At the control examination after 1, 2, 3 months anatomical and functional results remained stable.
Patient L., aged 45, diagnosed with OU - Vozrastayuschey degeneration. OS - Wet form. OD - Scar form. Visual acuity D=0.01 Nicholas/ OS=0.07 Nicholas OS - In the macular area minor prominence retinal exudative detachment of the pigment epithelium, neovascularization.
The data of ultrasound scan OS - When the axial position of the probe below the optic nerve disc reticulated shell rough, prominenet in the vitreous body at 0.5 mm.
Data HRT OS - laser scan redintegratio macular area is visualized plot heterogeneous reflexivity, prominere in the foveal region to 477 mcm. The swelling index increased to 2.12. The patient was treated declared method.
In the first stage, held the rate of exchange plasmapheresis, which consisted of 6 sessions conducted with an interval of 2 days. Upon completion of the course the patient in the operating conditions under local anesthesia in the left eye intravitreal introduced 1.25 mg Avastin. Parabulbarno entered antibiotic solution with dexatrim. Epibulbar installieren antibiotic solution. Antibiotic therapy was administered the day before surgery and five days after.
When viewed in the first day after surgery: OS - visual acuity = 0.1 (not correcting), the transparent cornea, anterior chamber, the average depth, lens transparent, vitreal cavity slight strengthening of destruction, in the macular area minor p is Eminence retina, subretinal exudation, neovascularization. At the control examination after 1 week visual acuity OS=0.2 (not correcting), the transparent cornea, anterior chamber medium, a transparent lens, the vitreous body of minor destruction, exudative lesion in the region of the macula decreased, marked resorption of subretinal fluid, reduction of newly formed vessels.
The data of ultrasound scan OS - In the area of the optic nerve disc reticulated shell locally prominenet in the vitreous body of 0.3 mm
Data HRT OS - laser scan redintegratio macular area in the dynamics reveals the decrease of thickness up to 456 μm. The swelling index decreased to 1.8. At the control examination after 1, 2, 3 months anatomical and functional results remained stable.
Thus, the proposed method for the treatment of macular edema of various origins is pathogenetically justified and improves the efficiency of treatment, and reduce the frequency of intravitreal injection antimajoritarian drugs. The method is easily reproducible in the hospital and when it is achieved the specified technical result. Thus, the claimed invention meets the criterion of "industrial applicability".
1. Method for the treatment of macular edema of various origins,including exchange plasmapheresis course of 6 sessions carried out with an interval of 2 days, characterized in that after it is conducted additionally a single intravitreal injections antimajoritarian drug.
2. The method of treatment according to claim 1, characterized in that as antimajoritarian of the drug is injected Avastin at a dose of 1.25 mg or Lucentis at a dose of 0.5 mg.
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to pharmaceutics and medicine and covers a protective agent for neural retina cells containing a compound of general formula (1) or its salt as an active ingredient, a method for prevention or treatment of diseases associated with involvement of neural retina cells and application of the compound of formula (1) for prevention or treatment of the diseases associated with involvement of neural retina cells.
EFFECT: invention provides high protective and medical effect.
16 cl, 1 dwg, 15 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to pharmaceutics, more specifically to a pharmaceutical composition for treating pain and/or eye damages during surgical or physical operations or before eye operation, containing a combination of a parasympatholytic agent, a sympathomimetic agent and a local anaesthetic, differing that in the composition, the parasympatholytic agent concentration is 0.015 to 0.025%, the local anaesthetic concentration is 0.75 to 1.25% and the sympathomimetic agent concentration is 0.2 to 0.4%.
EFFECT: invention provides rapid and prolonged anaesthesia, and also stable pupil dilatation for examination and surgical operation.
7 cl, 4 ex
SUBSTANCE: invention refers to medicine, namely to ophthalmology and can be used in treating neovascular glaucoma. Avastin in dosage 1.25 mg is introduced into the anterior chamber. Said preparation is introduced simultaneously subconjunctivally in two opposite sectors 2.5 mg in each. Then 7-14 days later, counteropening fistulisation in two opposite sectors follows.
EFFECT: method allows reducing number of intra- and postoperative hemorrhagic complications, providing stable normalisation of intraocular pressure.
SUBSTANCE: invention belongs to polymeric container for storage of prostaglandin F2α derivate aqueous preparation. Derivate has at least one fluor atom in its molecule. Polymeric container is made of propylene/ethylene copolymer in which propylene/ethylene ratio varies from 94.0/6.0 to 99.5/0.5. This container provides long time storage of prostaglandin F2α derivate liquid aqueous solution.
EFFECT: long time storable in aforementioned polymeric container product is offered.
5 cl, 1 dwg, 1 ex
SUBSTANCE: invention belongs to medicine, notably to ophthalmology. In lacrimal ductus, at 1-2 mm depth must be instilled 0.1-0.2 ml of the chlorine e6 covalently bound conjugate with human albumin in the molar ratio 1:2.5. Zone of instillation must be exposed to laser light with optical flux 500 mW during 1-2 minutes. Light's wavelength must comply with maximum absorption of optical emission by chlorin e6.
EFFECT: method allows to block lacrimal passages effectively and atraumatically up to necessary capacity.
SUBSTANCE: invention belongs to medicine, notably to ophthalmology, and can be used for treatment of neovascular terminal glaucoma. Patient receives intravenous transfusion of photosensitiser (PS) of chlorin series in amount of 0.8-1.1 mg/kg during 7-10 minutes. 5 minutes later eye's musculi recti must be exposed to laser light through conjunctiva at places of their insertion onto sclera, with the device, fixed to projection places of insertions in each quadrant. Light's wavelength must comply with maximum absorption of optical emission by (PS), radiation density rate must be 200-250 J/cm2.
EFFECT: method allows to avoid surgery, provides possibility to dose laser impact at eye's musculi recti, provides persistent depression of intraocular pressure and partial regress of iris neovascular net.
1 tbl, 1 ex
SUBSTANCE: invention refers to medicine, particularly to ophthalmology and concerns treating conjunctiva nevus. That is ensured by administration of tabletted or capsulated chitosan in a dose 125-300 mg 2-3 times a day within a month.
EFFECT: method provides effective treatment of the disease without surgical intervention.
SUBSTANCE: invention refers to medicine, particularly to a method of treating ophthalmopathies. The method of treating an ophthalmopathy in a mammal by recovery from mammal's bone marrow of a population of haematopoietic stem cells of a negative lineage which includes precursor endotheliocytes, transfection of the prepared population with a gene which functionally codes a fragment of antiangiogenic protein T2 of human tryptophanyl-tRNA-synthetase, and the following introduction in a vitreous body of the population of transfected cells in amount sufficient for symptomatic relief. The method of transgene delivery in a retinal vasculature of the mammal by introducing in the mammal's vitreous body of the population of haematopoietic stem cells of the negative lineage including precursor endotheliocytes where the cells are transfected with the antiangiogenic fragment of protein T2 of human tryptophanyl-tRNA-synthetase.
EFFECT: method of treating the ophthalmopathy is novel and highly effective.
2 cl, 27 dwg, 2 tbl, 10 ex
SUBSTANCE: for prevention and treatment of retinopathy in dismature infants with age of gestation from 29 weeks onto both child's eyes immediately after birth by lightproof bandage is applied. In addition, rectally daily during 3-4 months plasma is introduced, obtained from parent's blood, who was in conditions of darkness with opened eyes during 30-45 minutes.
EFFECT: invention ensures formation of morphologically and functionally full-fledged retina by removal of damaging light influence on retina and supply of child's organism with energetic and plastic material, obtained from parent's blood plasma.
2 cl, 2 ex
SUBSTANCE: introductrion of Retinalamin medication in Tenon's space through single-channel catheter by 2.5 mg 2 times per day during 5 days is realised.
EFFECT: method allows to ensure longer effect from application of medication, increase visual functions, reduce amount of side effects.
SUBSTANCE: there are offered device and method used to identify and recover various blood-dissolved particles of biological origin and biomolecules from liquids with applying suitable carriers and common immobilisation techniques. The device can be used both for discontinuous, and for direct and continuous processing of liquids.
EFFECT: background of the invention involves application in animals, biotechnology, including biological tests, and clinical diagnostics.
12 cl, 11 dwg
SUBSTANCE: invention concerns medicine, namely efferent methods of treatment. For this purpose intravenous injection of 400 ml of a 0.06% sodium hypochlorite solution with the subsequent low-flow ultrahemofiltration is performed. The way allows increasing efficiency of detoxicating of an organism at the expense of transfer of toxins from hydrophobic to hydrophilic condition.
EFFECT: rising of efficiency of detoxicating of an organism at the expense of toxins transfer from hydrophobic to hydrophylic condition.
2 tbl, 1 ex
SUBSTANCE: invention concerns medicine, namely to oncology, surgery and an intensive care and can be used as correction of a post-evacuation syndrome at patients with an intense ascites owing to a peritoneum carcinomatosis. For this purpose excision of an ascitic liquid is performed to the patient. Then the received ascitic liquid is concentrated and filtered by means of the haemodialysis filter, and then the concentrate is filtered with the help of a plasmafilter. A hypochlorite of sodium for oxidation, Cefazolinum 2.0 g/l and Prednisolonum of 90 mg/l with the subsequent reinfusion of a liquid to the patient are added to the received filtrate.
EFFECT: effective correction hypovolemic and hypoproteinetic disorders at patients with the given pathology at the expense of injection of autoascitic liquid with maximum increased concentration of protein with an invariable parity of its fractions, the lowered concentration of molecules of average mass and as much as possible remote atypical cells.
SUBSTANCE: group of inventions refers to medicine, namely to efferent treatment methods, and can be used for viral infection treatment. Therefor there are disclosed versions of method and an apparatus. The method includes blood or plasma sampling thereafter run through a porous hollow-filament membrane wherein lectin molecules are immobilised in a porous membrane exterior. The apparatus includes a processing chamber for blood or plasma sampling with contained lectin, and a porous membrane wherein blood or plasma cells cannot run through said membrane and contact with lectin.
EFFECT: inventions ensure effective isolating viral particles from blood or plasma due to substance molecules not being specifically affined to a target molecule, but contacting high-mannose viral glycoproteins or their fragments.
33 cl, 8 dwg, 10 ex
SUBSTANCE: system plasmapheresis line is connected to mass exchanger with hemosorbent supplied with erythromass at rate10 ml/min. Volume of exfused plasma is filled with plasma-substituting solutions.
EFFECT: allows for higher efficiency of detoxification therapy, reduction of complications associated with hemosorption.
1 ex, 1 tbl, 1 dwg
SUBSTANCE: invention concerns medicine, namely to orthopedic surgery and can be used at orthopedic operative measures with a prognosticated significant or massive hemorrhage, in particular, during endoprosthesis replacement of joints. For this purpose directly ahead of anaesthesia provide achievement of acute euvolemic hemodilutions by taking of an autoblood with a restoration of hemorrhage with crystalloids. Provide a controlled hypotension by administering of anaesthetic during all operative measure. For provision of intraoperative normovolemias perform administering of Gelofuzine and Reamberine preparations. Before wound mending, perform a reinfusion of the autoblood taken before the operation. Then carry out drainage of an operational wound performing in step by step with a reinfusion of drainage blood of high degree of clearing. Administer anticoagulants in 12 hours after an operative measure.
EFFECT: prevention of implantation syndrome.
SUBSTANCE: filter contains device for removal of non-leukocytic blood components, filtrating chamber and filtering unit located in-between, and filtering unit is hydraulically connected with cross-flow chamber and filtrating chamber. Cross-flow chamber is furnished with inlet and outlet. Inlet is provided for introduction of blood sample components containing leukocytes in cross-flow chamber and is in parallel with filtering unit surface. Outler is located in centre of cross-flow chambers against filtering unit surface; filtering chamber is furnished with filtering outlet. Average size of filtering pores is within range approximately 1-10 micron, providing blood component enrichment with leukocytes as blood sample flow passes through filtering unit. Versions of leukocyte enrichment using given filter are discovered.
EFFECT: provided sterility; cell viability and immunotherapeutic cellular activity.
59 cl, 9 dwg, 4 tbl, 13 ex
SUBSTANCE: the present innovation deals with the methods of cyclic extracorporal lymph purification against low-density cholesterol-lipoproteides (LDCL) and could be applied in treating patients in case of atherosclerotic vascular lesion. The first lymph portion should be withdrawn out of thoracic lymph duct by gravity into the external tank to be guided onto immunosorbent, moreover, simultaneously it is necessary to sample the next portion. Then the purified first portion should be returned by drops into one of the main veins of a patient and the second comes onto immunosorbent along with accumulating the third portion in the tank. The cycles ends on returning the purified third portion into one of the main veins. Moreover, period of time necessary for every stage of lymph purification upon immunosorbent should be prolonged by 20-40%. After that the following solutions should be passed through immunosorbent: glycine-HCl buffer at pH 2.5, phosphate buffer at pH 7.4 and physiological solution. The procedure mentioned should be carried out for about 7-10 d at the background of the diet at daily caloricity being up to 1500 kcal and sharp restriction of fats and carbohydrates. The innovation enables to withdraw LDCL out of lymph till their entering the circulation that prevents the contact of LDCL with hepatocytes and protein hydrolysis at developing free cholesterol and decreases damaging action of LDCL upon vascular endothelium.
EFFECT: higher efficiency of therapy.
2 cl, 3 dwg
FIELD: efferent medicine; extra corporal hemocorrection.
SUBSTANCE: method and device can be used for hemofiltration. Hemofiltration is carried out by means of patient and donor two hemofiltration circuits connected in series. Any circuit has blood pump, membrane mass exchanger, air trap, combined pressure-and-vacuum gage for checking venous and arterial pressure, measuring container with scales, reversible pump, electromagnet valves and devices indication on tear in membranes of mass exchangers. Measuring containers with scales in patient and donor hemofiltration circuits are mounted for feed patient and donor hemofiltrate in them correspondingly and for return of patient's hemofiltrate for discharge and donor hemofiltrate - to patient's air trap. Patient's hemofiltrate is replaced by full-value donor's hemofiltrate. Measuring container with scales in circuit of return of replacing solution is mounted for feed of replacing solution from container filled with replacing solution and for return of replacing solution into donor's air trap.
EFFECT: improved efficiency of hemofiltration; improved speed of elimination of toxic matters from patient's organism.
2 cl, 1 dwg, 1 tbl, 1 ex
FIELD: medical equipment.
SUBSTANCE: single-use hemosorption column can be used for extra-corporal cleaning of blood and plasma from ecto- and endotoxins. Column has cylindrical case, cone-shaped caps, and couplings for inputting and outputting blood, which couplings are made onto plugs conjugating with caps and having through coaxial openings. Column also has removable caps for couplings, filters disposed inside case under cone-shaped caps and made to have opening in center. One filter is provided with lock member. There are rings made of current-conducting materials between edges of case and cone-shaped caps; rings adjoin caps. Couplings are made in form of cones to have stepwise external surface. Nuts are screwed upon caps of column. Bibs with plugs are screwed upon nuts; bibs close couplings and they have ability of fixing couplings to form connectors at input and output of cavity for blood. Nuts are provided with internal thread at their top part to connect Luer-lock blood-conducting duct. Washers are put among nuts and bibs. Diameter of case relates to length of column as 1/2-1/3.
EFFECT: improved safety; higher reliability of operation; liquid tightness.
3 cl, 2 dwg, 4 att
FIELD: medicine; oncology.
SUBSTANCE: invention can be used for treatment of an acute myelogenetic leukemia or myelodysplastic syndrome. For this purpose use a combination of preparations hemetuzumab ozohamicin, daunorubicin and cytarabinum in certain doses and regimens.
EFFECT: invention promotes effective treatment of the specified diseases due to synergistic effect at influence of these preparations on an organism.
2 cl, 2 ex