Method of treating liver abscess in children

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to abdominal surgery, hepatology and methods of detoxication, and can be applied for treatment of liver abscess of different etiology. For this purpose after sanitisation of purulent nidus cavity of liver abscess is processed with 0.25% solution of derinate, then blood sampling is carried out in quantity 150-200 ml of blood, after centrifugation of which erythrocytes are returned to patient, and leucocytes are extra-corporeally processed with 0.5% solution of glutoxim in dose 1 ml and diluted in 50-100 ml of 0.9% solution of NaCl with following intravenous drop introduction, and from the following day into cavity introduced is 0.25% solution of derinate in dose 1.5 ml one time per day during 5 days.

EFFECT: method makes it possible to reduce treatment duration and reduce number of complications due to improvement of indices of cellular link activity, connected with increase of quantitative indices of T-helpers and T-suppressors at the background of increase of phagocytic activity of neutrophils, as well as reduction of erythrodieresis processes due to normalisation of APFC content and humoral link of immunity.

2 tbl

 

The invention relates to medicine, namely to abdominal surgery, Hepatology and methods of detoxification, can be used in the treatment of liver abscesses of various etiologies.

Known methods of treatment of liver abscesses: the redevelopment of purulent, antibiotic therapy, anti-inflammatory, desensibiliziruyuschee therapy[1, 3, 4].

The disadvantages of these methods is that comprehensive treatment is not included in the use of immunomodulators, because it is not considered developing in patients with T cell-immune deficiency and inhibition of phagocytic activity of neutrophils and macrophages. And do not include the use of immunomodulators.

Closest to the proposed is the use of Immunostimulants: nukleinat sodium in the age dose, adjuvant at a rate of 0.1-0.2 mg/kg of body weight once a day/m or IFN in a daily dose of 50,000 IU/kg [2, 5]. Their disadvantage is a short period of 4-12 hours

The objective of the proposed method is to increase the effectiveness of treatment of liver abscesses and prophylaxis of septic complications in patients with liver abscesses.

The task reach due to the fact that later after rehabilitation purulent process cavity 0.25% solution Derinat, then hold the blood in the number of 150-200 ml, centrifuged after the I which the red blood cells returned to the patient, and leukocytes in vitro treated with 0.5% solution of Glutoxim dose of 1 ml and diluted in 50-100 ml of 0.9% NaCl solution followed by intravenous drip their introduction, and the following day injected into the cavity 0 25% solution Derinat in the dose of 1.5 ml once a day for 5 days.

The method is as follows. Patient with abscess after rehabilitation purulent lesion in the liver cavity treated with 0.25% solution of Derinat, then spend the session in vitro treatment of cells with 0.5% solution of Glutoxim dose of 1 ml of blood is collected from a vein of the patient is carried out in a number of 150-200 ml Vials eksponirovannoi and heparinised blood centrifuged 15 min with a speed of 2000 rpm, after which the plasma exposium. In a sterile vial collect leukocyte film and diluted with 0.9% NaCl - 100-150 ml medium 199 - 200-250 ml of red cells returned to the patient in a bottle impose Glutoxim 1 ml of 0.5% solution of 1×109cells; the resulting solution is incubated for 90 min at 37°C, then centrifuged 15 min with a speed of 2000 rpm, the bottle is removed the solution to leukocyte film, further leukocytes washed 3 times with sterile 0.9% NaCl - 390-485 ml, washed leukocytes diluted with 0.9% NaCl - 50-100 ml and intravenously administered to the patient. The following day the patient also conduct intracavitary introduction: ,25% solution Derinat in the dose of 1.5 ml once a day for 5 days.

Comparison of treatment results was performed in 29 patients aged from 2 years to 14 years. Observation period: after 1 session, after 3 sessions, and after 5 sessions. To assess the effectiveness of the treatment was studied data the immunological status in the control group (I) (treated by standard methods) and the group (II) (treated our proposed method). In the course of treatment established (table 1)that the proposed method can improve clinical and laboratory parameters of immunological status relative to the control group (I).

When analyzing immunograms patients with liver abscesses treatment group (II) in the postoperative period identified: reducing the absolute number of lymphocytes by 86% to 0.26±0,02 (norm 1,89±0,09) after 1 session, after 3 sessions the level of absolute number of lymphocytes remained reduced by 59% to 0.78±0.03 in, and after the 5th session to 1.72±0,05 (9% below normal). This index patients of the control group (I) after the 5th session was reduced by 57,7% below normal (0,8±0,03·109). The relative number of lymphocytes in the treatment group (II) after 1, 3 and 5 sessions were respectively 31,2±0,9%, 50,2±0,87% and 62.9±2,4 (the norm 64,2±2,1%). Patients of the control group (I) the figure of the postoperative period after the 5th session was equal to 42.1±1,8%.

Patients of the studied group (II) the level of T-helper cells (Th) is reduced to 18.4±0,83% (the ri norm 32,3±1,2%) after 1 session to 29,09±1,62% after 3 sessions and after the 5th session - to 41.8±2.41 per cent. At a time when patients of the control group (I), this figure remained reduced after the 5th session to 19.6±0,76% (12% below normal).

In group (II) T-suppressor (TS) is reduced to 13.4±0,08% (at a rate of 24.8±0,46%) after 1 session, to 18.8±0,37% after 3 sessions and after the 5th session, the patients of the studied group (II) was to 25.3±0,65%, and patients of the control group (I) after the 5th session - 19,6±0,76 (21% lower than the norm).

The index ratio Th/TC patients of the studied group (II) after 1, 3 and 5 sessions of the postoperative period were slightly different from the norm (1,3±0.02) and were respectively 1,37±0,02, 1,54±0,I 1,58±0,01.

Phagocytic index in patients with liver abscess treatment group (II) in the postoperative period after 1 session was 56.4% below normal and was 33.6±1,15% (norm 77±1,2%), after 3 sessions levels remained reduced by 27% to 56,07±0,94%, and after 5 sessions before 81,27±0,78%, which was slightly above normal. Phagocytic index in patients with liver abscess control group (I) at the time after the 5th session was 46,2±0,49, which is 40% lower than normal.

The normal level of killers autologous erythrocytes (ABC) (II) the study group was increased after 1 and 3 sessions of the postoperative period and amounted to 9.15±0.02 and 5,02±0.01 respectively when the normal value of this indicator (0-5%), after 5 teensagency indicator was equal to the norm and was 2,52±0.03 in.

Table 1
Immunological parameters in children of control group I (12 patients) and treatment group II (17 patients) with liver abscess
IndexNorma1 session3 session5 sessions
Control group IThe studied group IIControl group IThe studied group IIControl group IThe studied group II
T-lymphocyte.,1091,89±0,090,23±0,030,26±0,020,41±0,060,78±0,030,8±0,031,72±0,05*
T-lymphocyte., %64,2±2,128,5±0,731,2±0,9* 32,8±0,650,2±0,87*42,1±1,862,9±2,4*
Lymphocytes, 1093±0,20,74±0,080,82±0,05*0,8±0,061,65±0,061,9±0,82,84±0,03*
TX, %32,3±1,214,8±0,0718,4±0,83*17,9±0,929,09±1,62*28,4±1,241,8±2,41*
TC %24,8±0,469,1±0,0413,4±0,0812,3±0,418,8±0,3719,6±0,7625,3±0,65
TX/TC, ed1,3±0,021,62±0,011,37±0,02*1,45±0,021,54±0,01*1,44±0,011,58±0,01
Yg G, g/l7,49±0,269,6±0,2410,2±0,32*9,9±1,112,3±0,56*10,1±0,812,2±0,67*
Yg And g/l0,86±0,121,7±0,21,8±0,131,9±1,022,34±0,152,4±0,073,06±0,09
Yg M g/l1,12±0,030,82±0,021,05±0,06*0,9±0,031,34±0,08*1,1±0,011,4±0,05*
CEC $ 50±2,1the 97.6±1,4272,4±1,3793,2±2,159,2±1,36*to 82.9±1,0250,14±1,61*
Phagocytic index, %77±1,22B,3±,2 33,6±1,1532,4±0,8756,07±0,9446,2±0,4972,27±0,78*
ABC, %0-59,65±0,03to 9.15±0,02*of 7.97±0,045,02±0,01*5,42±0,032,52±0,03
* - statistically significant differences compared with the comparison group (P<0,05)
Table 2
Comparative results in terms of normalization of blood flow and recovery control and main groups
Group (n=29)Bed-dayComplications
The comparison group I (n=12)38±1,53 (7,9%)
The comparison group II (n=17)21±1,3*no
* - statistically significant differences compared with the comparison group (P<0,05)

Changes of cellular immunity in patients with liver abscesses in the postoperative period, combined with changes in the humoral link: the level of immunoglobulin A (IgA) and immunoglobulin G (IgG) was increased and accordingly made after 1 session of the postoperative period in patients study group (II) of 1.8±0,13 g/l, and 10.2±0.32 g/l (normal 0,86±0.12 g/l and 7,49±0.26 g/l), after 3 sessions of the postoperative period was 2.34±0.15 g/l and 12.3±0.56 g/l after 5 session - 3,06±0.09 g/l and 12.2±0,67 g/l

Thus, in patients with liver abscess in the study group (II) compared with the control group (I) when using extracorporeal immune therapy in combination with drainage of the abscess and washing the cavity with an aqueous solution of Derinat showed a significant improvement in indicators of immunological indexes in early postoperative period, which approached normal levels after 5 sessions of treatment. This was confirmed by the improvement in activity of the cellular link associated with an increase (in comparison with the control group) quantitative indicators of T-helpers and T-suppressors on the background of increasing phagocytic activity of neutrophils, and relief processes retroversa due to the normalization of the content of ABC gumoralnogo immunity.

On the basis of obtained data we can conclude that the use of extracorporeal immune therapy in combination with drainage of the abscess and washing the cavity with an aqueous solution of Derinat had a positive effect on the condition and function of the immune system by reducing the level of endotoxemia.

Thus the proposed method can reduce the duration of treatment 2 times, to exclude the total number of complications (table 2).

Literature

1. Akhaladze GG, Tsereteli YOU Colagiovanni abscesses in the liver // Consilium medicum. - 2005. - V.7, №2. Surgery (ADJ.). - P.1-9.

2. Wisniewski, VA, Kubyshkin VA and soavtorami on the liver. Guide for surgeons // - M: Miklos, 2003. - 156 S.

3. Parhisenko Y.A., deaf A.A. et al. Diagnosis and treatment of liver abscesses // Surgery. - 2000. No. 8. - S. - 35-37.

4. The shochet Y.N., Fokeev S.D. et al. The influence of local continuous intraarterial antimicrobial therapy in the postoperative period in patients with liver abscesses // Analy surgery. - 2008. No. 1. - S. - 50-53.

5. Chen, S.C., Tsai, S.J., Lee Y.T., et al. Predictors mortality in patients with pyogenic liver abscess // The Neiderlands journal of Medicine. - 2008. - Vol.66, No. 5. - R-203.

A method of treatment of liver abscesses, including reorganization of purulent lesion in the liver, characterized in that it further after rehabilitation purulent process cavity 0.25%solution Derinat, C is the carry out blood collection in the amount of 150-200 ml, after centrifugation which the red blood cells returned to the patient, and leukocytes in vitro treated with 0.5%solution of Glutoxim dose of 1 ml and diluted in 50-100 ml of 0.9%NaCl solution followed by intravenous drip their introduction, and the following day injected into the cavity of 0.25%solution of Derinat in the dose of 1.5 ml once a day for 5 days.



 

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4 ex, 2 tbl

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10 tbl

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2 ex, 3 tbl

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4 tbl

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1 tbl, 9 ex

FIELD: chemistry.

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21 cl, 320 ex, 3 tbl

FIELD: medicine.

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1 ex

FIELD: medicine.

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1 ex

FIELD: medicine.

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2 tbl, 1 ex

FIELD: medicine.

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12 cl, 1 dwg, 1 tbl, 23 ex

FIELD: medicine.

SUBSTANCE: sampling of blood from patient's ulnar vein with first and second syringe-test-tubes is carried out. First syringe-test-tube is centrifuged with acceleration 250 g for 10 minutes. Formed plasma and coagulated blood in second syringe-test-tube are centrifuged with acceleration 1000 g for 10 minutes. Platelet-poor plasma is separated from platelet-enriched plasma. Activator of platelet-enriched plasma is prepared from supernatant fluid after centrifugation of coagulated blood and platelet-poor plasma, with weight ratio in fractions: 1:1, and 10% calcium chloride solution. The latter - in drop manner, mixing until required mixture concentration is obtained. Platelet-enriched plasma is mixed with activator with weight ratio in fractions 1:3 respectively.

EFFECT: application of method allows to realise more complete isolation of platelets from sampled blood, which increases efficiency, physiologicity and safety of obtained plasma.

2 cl

FIELD: medicine.

SUBSTANCE: system includes a kit of disposable elements for transportation of liquid, which are preliminarily connected or include aseptic connectors for creation of connections between them in aseptic way, or are adapted for being aseptically connected. Kit includes three sets of disposable sterile elements: set for collection, set for processing and set for transplantation, packed in blister packing on carrier, such as tray, which has one department, containing each connected with other set of said kit. System can be applied for obtaining platelet concentrate for separate application. Method of collection and processing of cell subpopulation includes collection of isolated cells in collection chamber, connected with isolation device, processing of cells in centrifugal operation chamber, which is the same chamber as the chamber for collection, or which is connected with collection chamber, and collection of processed cells in chamber for reinfusion, which also is the same chamber as the operation chamber, or which is connected with operation chamber, and delivery of processed cell subpopulations back to the patient.

EFFECT: application of invention makes it possible to ensure automatic processing in closed system in on-line mode.

17 cl, 9 dwg

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

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.

EFFECT: method improves clinical effectiveness due to fast pain management, enlarged range of active and passive motions, normalised muscular tonus, increased muscular strength and corrected vegetovascular disorders.

6 cl, 3 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, oncology, and can be used for treatment of malignant lung neoplasms in experiment. For this purpose performed is extracorporal irradiation of autoblood with red incoherent light λ=0.67 mcm dose W=3.06 J/cm2 in continuous mode with exposition duration to three minutes. After that 15-20 minutes later into said blood added is cyclophosphane in dose 40 mg/kg and the mixture is incubated for 40 minutes at T=37°C. After that it is re-infused into subclavian vein of the animal.

EFFECT: claimed method allows to reduce terms of anti-tumour treatment, increase efficiency of cyclophosphane action, reduce its toxic manifestations, increase animals' life term, increase non-specific anti-tumour resistance, activate anti stressor mechanisms.

2 tbl

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to gynecology and concerns the integrated treatment of tuboperitoneal infertility. That is ensured by low-intensity infrared lasing at power 150 Wt, wave length 0.89 mcm of the inguinal lymph nodes and a skin projection of the lumbosacral plexus. The exposure time is 1 min for each region for 1st session. Thereafter, the exposure time is increased to 3 minutes during 10 sessions. It is combined with local intraendometrial introduction of an antibacterial agent and an immunomodulator. Besides the treatment involves a number of plasmapheresis sessions and introduction of nonsteroidal anti-inflammatory drugs, antioxidants, desensitisers, and vaginal sanitation.

EFFECT: method provides effective restoration of menstruation and reproductive function.

2 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to medicine, namely to physiology and physiopathology. Substance of the invention consists in an application of peptide Gly-His-Lys of formula (NH2) Gly-His-Lys (COOH) for an analgesic effect in pain caused by thermal irritation.

EFFECT: invention allows applying known peptide Gly-His-Lys with manifested analgesic effect for a new purpose.

1 tbl

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