Method of treating secondary lymphedema of upper extremities

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and can be used in treating patients with secondary lymphedema of upper extremities. That is ensured by the introduction of autolymphocytes extracorporally processed with Roncoleukin and dissolved in normal saline in subcutaneous fat of an injured extremity in a projection of lymph node basins along a medial and lateral surface of forearm. The solution is introduced in 20 points by 0.5 ml containing 20 to 30 million cells per each point on the average. The procedures are thrice-repeated every 72 hours.

EFFECT: method allows to intensify lymphatic outflow from the injured extremity, to reduce paravasal inflammations of subcutaneous fat due to stimulating cell components of the immune system.

8 tbl, 1 ex

 

The invention relates to medicine, namely to surgery. Can be used in the treatment of patients with edema of the upper extremities.

This method is not unique, is ease of implementation, availability, efficiency.

The method consists in the introduction into the subcutaneous fat of the upper limb of autolymphocyte activated by ronkoleykin three times with an interval of 72 hours in dilution to 10 ml of 0.9% solution of sodium chloride.

To obtain the fraction of autolymphocyte spend Tifferet separator blood cells Haemonetics MCS+. Selected autolymphocyte subjected to incubation in vitro with an immunomodulator Roncoleukin (100 u/ml) for 1.5 hours at 37°C in thermostat TC 1/20. Then an injection of autolymphocyte activated by ronkoleykin, in dilution to 10 ml of 0.9% sodium chloride solution in the subcutaneous tissue of the affected limb in 20 points with an interval of up to 2 cm (0.5 ml of a solution containing on average from 20 to 30 million cells per point) in the projection of lymphatic collectors on the medial and lateral surface of the forearm of the affected limb. Tifferet and injection autolymphocyte produced three times with an interval of 72 hours.

The technical result of the invention is to improve the effectiveness of the treatment of lymphoedema, the mind is icenii parabasal inflammation of the subcutaneous tissue of the affected limb, improving the functioning of the lymphatic collectors, prevention of erysipelas by stimulating cellular immunity.

The advantages of the proposed solution:

- an impact immunomodulator Roncoleukin on autolymphocyte in vitro conditions;

- increased lymphatic drainage from the affected limb;

- the possibility of elimination from the body a certain number of autolymphocyte, can affect the inflammation.

To assess the effectiveness of the proposed method of treatment was a comparative analysis of medical records of 30 patients with edema of the upper extremities, which was conducted by the conventional treatment, in the tables group designated as "K", half (52.9 per cent) in history was absent erysipelas, and 21.6% and 25.5% of erysipelas was accordingly once and recurrent. The main group consisted of 26 patients with edema of the upper extremities, which, in addition to standard treatment, underwent a course of subcutaneous injections of autolymphocyte activated by ronkoleykin, three in number, the group denoted in the tables as "On", more than half (54.1 per cent) suffered erysipelas, with 20.6% of erysipelas wore a recurrent nature. Evaluation of the effectiveness of therapy was conducted by sravnitel the aqueous impedance metric analysis, thermal imaging, anthropometric studies, ultrasound, soft tissues of the affected limb, realestateradiousa.com research. These surveys were conducted upon admission of the patient in the hospital and at discharge. Within 1 year after treatment were estimated number of recurrent erysipelas.

The result showed that after the proposed treatment using subcutaneous injections of autolymphocyte decreased the total circumference of the affected limb by 5.8%. A more significant reduction was noted at the expense of distal segment (6.6 percent). The bright reflection of the positive impact the proposed treatment is the dynamics of the difference of the total circumferences of the affected and the healthy limb before and after treatment, which was 45.5%. Also proposed is a method of treatment led to a decrease of the active component of the resistivity of the soft tissues at all levels of study, to increase skin temperature, increased speeds of regional lymph flow, improving peripheral venous blood flow. Recurrence of erysipelas on the background of therapy and in the follow-up period from 6 months to 12 months registered in 9.5% of patients in the main group, while in the control group in 22,2% of patients with other conditions being equal: the specied n the mi recommendations after discharge from the hospital, avoiding stings stinging insects, preventing microtraumas, cracks on the affected limb.

Comparative data are given in tables.

Table No. 1
Data anthropometric studies of the upper extremities "K"(cm, M±M)
IndexHealthy limb"To" Affected limb
Before the treatmentAfter the treatment
The total volumeto 150.7±2,3170,8±2,32165,7±2,41,2
Proximally72,6±2,370,2±2,41
Distalof 98.2±1,395,5±1,51
The difference in volume20,1±2,215,2±1,81
Note:1- is Alicia reliable compared with before treatment (p< 0.05)
2- The difference is significant in comparison with the healthy limb (p<0.05)

Table No. 2
Data anthropometric studies of the upper extremities "O"(cm, M±m)
IndexHealthy limb"O" the Affected limb
Before the treatmentAfter the treatment
The total volume156,1±2,3179,8±2,12168,7±1,91,2
Proximally78,3±2,3of 74.3±2,41
Distalof 101.5±1,994,4±1,51
The difference in volume23,2±2,220,1±1,81
Note:1- The difference is significant in comparison with the figures before Leche is based (p< 0.05)
2- The difference is significant in comparison with the healthy limb (p<0.05)

Table No. 3
Dynamics of speed lymphatic drainage in patients with lymph edema of the upper extremities in the diseased and healthy limbs (in Ohm/sec)
The group of patientsThe affected limbHealthy limb
Before the treatmentAfter the treatmentBefore the treatmentAfter the treatment
"K"0,29±0,040,34±0,020,63±0,090,60±0,11
"O"0,31±0,090,47±0,04*0,56±0,020,58±0,05
(*) - reliability of differences with the control group, p<0,05.

Table No. 4
Dynamics of volumes of peripheral lymph in patients with lymph edema of the upper extremities in the diseased and healthy limbs (in Ohms).
The group of patientsThe affected limbHealthy limb
Before the treatmentAfter the treatmentBefore the treatmentAfter the treatment
"K"0,16±0,040,22±0,060,26±0,040,30±0,03
"O"0,16±0,090,27±0,03*0,34±0,120,37±0,06
(*) - reliability of differences with the control group, p<0,05.

Table No. 5
Dynamics of volume of blood in the peripheral veins in patients with lymph edema of the upper extremities in the diseased and healthy limbs (in Ohms)
The group of patientsThe affected limbHealthy limb
Before the treatmentAfter the treatmentBefore the treatmentAfter the treatment
"K"0,16±0,040,22±0,060,26±0,040,30±0,03
"O"0,16±0,090,27±0,03*0,34±0,120,37±0,06
(*) - reliability of differences with the control group, p<0,05.

Table No. 6
These resistivity measurements of soft tissues with low-frequency impedancometry in the affected limb (Ω, M+m).
Level"O""K"
Before the treatmentAfter the treatmentTo l the treatment After the treatment
Shoulder/357,5±2,466±3,4162,7±2,263,8±2,4
Shoulder n/352±260±2,9154,1±3,157,4±2,7
Forearm/348±1,956,5=2,6143,2±2,347,1±2,0
1- differences in performance before and after treatment reliable, p<0,05

Table 7
Dynamics of ultrasound subcutaneous fat "To" (mm)
Levels
dimension
Healthy limbThe affected limb
Before the treatmentAfter the treatment
Shoulder1.47±0.062,1±0,122 1,87±0,112
Forearm0.62±0.041,84±0,1521,55±0,162
Brush0.21±0.040,62±0,120,45±0,092
1-Differences were significant in comparison to before treatment (p<0.05)
2-The difference is significant in comparison with the healthy limb (p<0.05)

0.67±0.05
Table 8
Dynamics of ultrasound subcutaneous fat "O" (mm)
Levels
dimension
Healthy limbThe affected limb
Before the treatmentBefore the treatmentAfter the treatment
Shoulder1.57±0.071,91±0,0721,77±0,061,2
Forearm1,74±0,0921,55±0,0,82
Brush0.22±0.030,6±0,920,48±0,011,2
1-Differences were significant in comparison to before treatment (p<0.05)
2-The difference is significant in comparison with the healthy limb (p<0.05)

Clinical example: Patient J., 39 years. Diagnosis: Secondary lymphedema of the left upper extremity II senior In 2003 was made a radical mastectomy on the left, before and after surgical treatment of produced chemo - and radiation therapy, noted the appearance of swelling of the left upper extremity since 2004, over time, the swelling increased in size. Erysipelas of the left upper limb was moved in the summer of 2007 has Repeatedly passed a course of conservative treatment in the hospital of Nikiel WITH the RAMS, with a temporary positive result. Data anthropometry for admission: the circumference of the upper extremities respectively to the right/left in centimeters: brush 19/21, the wrist joint 16/21, the lower third of the forearm of 17.5/25, the upper third of the forearm 26/35, the lower third of the shoulder 27,5/37,5, the middle third of the shoulder 30 and 36. Survey anthropometry, impedancometry, realestaterama, those who louisianne study ultrasound examination of the subcutaneous tissue. Treatment - standard conservative treatment. The patient had three procedures cytapheresis, with an interval of 72 hours, the separator of blood cells with the release fraction autolymphocyte and the introduction of a dedicated autolymphocyte activated by ronkoleykin (100 IU/1 ml)in subcutaneous adipose tissue of the affected limb in the number of 400-600 million in 20 points in a dilution of 10 ml of 0.9% sodium chloride solution. During the course of treatment achieved a distinct positive clinical dynamics - the patient said reducing unpleasant subjective sensations (pain level at discharge was estimated it at 0.7 point), edema of the left upper extremity decreased, swelling became more soft. After completion of therapy observed decrease swelling of the left upper limb: brush 19/18, the wrist joint of 15.5/16, the lower third of the forearm 17,5/20,5, the upper third of the forearm 25/31,5, the lower third of the shoulder 27/32,5, middle third shoulder 29/32. Revealed an increase in the size of the active component of the resistivity of the soft tissues at all levels of studies: level of the brush before treatment - 41.5 Ohms after treatment 46 Ohms, at the level of the wrist joint before treatment - 41.5 Ohms after treatment is 49.5 Ohms, at the level of the middle third of the forearm before treatment is 47 Ohms, after treatment - 52,5 Om, on the level of the upper third of the forearm to treatment is - 48.5 Ohms after treatment 55 Ohms, at the level of the lower third of the shoulder to the treatment of 52.5 Ohms after treatment of 60.5 Ohms, at the level of the upper third of the shoulder before treatment - 57 Ohms after treatment 65,5 Ohms. Marked following the dynamics of skin temperature on the level of the brush before treatment of 28.4°C, after treatment to 31.8°C, at the level of the forearm before treatment is 29.1°C, after treatment by 33.1°C, at the level of the shoulder to the treatment of 29.4°C, after treatment and 33.5°C. According to realestaterama increased rate of venous outflow after a course of therapy with 0,61 Om/s before treatment to 0.79 Ohms/sec, the volume of the venous outflow from 0.36 to 0,49 Ohms on the brush, from 0.39 to 0.54 Ohms on forearm. Increase the speed of outflow of peripheral lymph after an appropriate course of therapy was: brushes - from 0.41 to 0.76 Ohms/sec, forearm - from 0.31 Ohm/sec to 0.63 Ohm/sec. It was noted the increase lymphatic drainage after treatment: from 0.12 to 0.36 Ohm - brush and from 0.12 to 0.46 Ohms on the forearm. During the observation period during the year does not have recurrence of erysipelas.

Using this method allows you to more effectively influence the pathological process by reducing inflammation in the subcutaneous tissue of the affected limb, improve lymphatic drainage.

A method for the treatment of secondary lymphedema of the upper limbs, characterized in that the subcutaneous fatty tissue on the Agen limbs in the projection of lymphatic collectors on the medial and lateral surfaces of the forearm injected with in vitro-treated ronkoleykin autolymphocyte, diluted with 0.9%sodium chloride solution, the introduction is carried out at 20 points 0.5 ml of a solution containing on average from 20 to 30 million cells for each point, the procedure is repeated three times with an interval of 72 hours



 

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2 cl, 2 ex

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12 cl, 11 dwg

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12 cl, 11 dwg

FIELD: medicine.

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3 cl, 2 dwg

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16 cl, 7 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment, namely to medical injectors with front loading and syringes, syringe interfaces, syringe plungers and adaptors for application with novel or existing medical injectors, in which syringe of special construction is made with possibility to be installed into injector and to be released from injector by means of split mechanism. Syringe for application with injector connects syringe-holding mechanism, which contains flexible ring. Syringe contains case, plunger, movably placed in case; at least one fastening element, connected with case. At least one fastening element interacts with flexible ring of syringe-holding mechanism for split fixation of syringe to injector. At least one releasing element is made with possibility to deform flexible ring in order to ensure syringe release from fastener to injector when syringe rotates around its axis with respect to injector. At least one releasing element is located in axial direction before at least one fastening element. Injector for injecting liquid from installed on it syringe contains case, drive element at least partly located in case and made with possibility of engagement with plunger, located inside syringe, and syringe-holding mechanism. Syringe-holding mechanism is connected with case and is made with possibility to intake syringe when it is moving axially backward with respect to syringe-holding mechanism irrespective of orientation of syringe around its axis. Syringe-holding mechanism in fact consists of flexible ring, held in fixed axial position in syringe-holding mechanism. In second version of injector implementation drive element contains flexible ring, located on it for engagement with plunger, located inside syringe. Flexible ring in first state is adapted for engagement with plunger and formation of connection with it, when plunger is turned around its axis into first position. Flexible ring, deformed to second state, is adapted for plunger release, when plunger is turned around its axis into second position. Syringe for application with injector, which contains syringe-holding mechanism. Syringe contains case, plunger, movably placed in case, and at least one fastening element, connected with case. At least one fastening element contains flexible ring, made with possibility of split fixation of syringe to injector.

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16 cl, 7 dwg

FIELD: medicine.

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EFFECT: in short terms method ensures recovery of obturative apparatus of rectum similar to natural, is low-traumatic and simple in application.

2 ex

FIELD: medicine.

SUBSTANCE: method involves the intravenous and/or intramuscular introduction of the drugs used in myelopathy, balneotherapy in the form of baths. Acupressure and manual therapy are applied in addition. The manual therapy requires such techniques, as ischemic compression, release phenomenon, fascial broach, postisometric relaxation of the muscles involved in a pathological process. Discontinuous therapeutic plasmapheresis is applied with using either Baxter, or Bekman, or Haemophoenix apparatuses, and/or extracorporal ultraviolet blood irradiations is ensured by the apparatus Isolda MD 73 M. The apparatus Cryo-Jet is used for cryotherapy with cooled dry air at the level of degenerative dystrophic changed vertebral motor cervical segments and muscle attachment points.

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6 cl, 3 ex

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